Rates of Cardiac Catheterization Cancelation for ST Elevation Myocardial Infarction after Activation by Emergency Medical Services or Emergency Physicians: Results from the North Carolina Catheterization Laboratory Activation Registry (CLAR)
Background—For patients with an acute ST segment elevation myocardial infarction (STEMI), cardiac catheterization laboratory (CCL) activation by emergency medical technicians (EMTs) or emergency physicians has been shown to substantially reduce treatment times. One drawback to this approach involves “over-triage” whereby CCL staffs are activated for patients who ultimately do not require emergent coronary angiography, or for patients who undergo angiography but are not found to have coronary artery occlusion.
Methods and Results—We examined CCL activation at 14 primary angioplasty hospitals to determine the course of management, including the rate of inappropriate activation. Among 3973 activations (29% by EMTs, 71% by emergency physicians) between December 2008 and December 2009, appropriate CCL activations occurred for 3377 patients (85%), with 2598 patients (76.9% of appropriate activations) receiving primary PCI. Reasons for inappropriate activations (596 patients, 15%) included ECG reinterpretations (427 patients, 72%) or the patient was not a CCL candidate (169 patients, 28%) The rate of cancellation due to reinterpretation of EMT's ECG (6% of all activations) was more common than for cancellation due to reinterpretation of emergency physicians' ECG (4.6%).
Conclusions—This represents the first report of the rates of cardiac catheterization laboratory cancellation for STEMI system activation by EMTs and emergency physicians in a large group of hospitals organized within a state-wide program. The high rate of coronary intervention and relatively low rate of inappropriate activation suggests that systematic CCL activation by emergency personnel on a broad scale is feasible and accurate, and these rates set a benchmark for STEMI systems.
- acute myocardial infarction
- emergency department
- ST-segment elevation myocardial infarction
- systems of care
- emergency medical services
- Received November 9, 2010.
- Accepted November 24, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited