Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation

Cardiovasc Revasc Med. 2016 Jun;17(4):219-24. doi: 10.1016/j.carrev.2016.03.015. Epub 2016 Mar 28.

Abstract

Background: Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤90min for favorable survival impact after STEMI. Efforts to achieve these targets may result in unnecessary emergent angiography for inappropriate activations.

Objective: Evaluate the frequency, trend and factors which are significantly associated with inappropriate for intervention cardiac catheterization laboratory (CCL) activation.

Methods: We analyzed 1764 consecutive emergent CCL activation for possible ST segment elevation myocardial infarction (STEMI) between 7/2005 and 8/2013. Inappropriate for intervention activation was defined as negative STEMI (incorrect diagnosis: insignificant coronary lesion, not requiring any intervention) and inappropriate patients (true STEMI but poor CCL candidacy).

Results: Inappropriate for intervention CCL activation occurred in 317 patients (17.9%): 292 incorrect diagnosis (negative STEMI diagnosis), 25 inappropriate patients, with no difference in the frequency based on time of the day (18.6% regular hours vs. 17.6% off-hours, p=0.6). On multivariable analysis, female gender (OR 1.9 [1.2-3.0]), African American race (OR 1.9[1.3-2.7]), and prior coronary artery bypass graft surgery (OR 3.6 [2.3-5.5]) were significantly associated with incorrect diagnosis (negative STEMI diagnosis) (all p<0.005) and hyperlipidemia (OR 0.2 [0.1-0.3]), tobacco use (OR 0.2 [0.1-0.3]), and stroke/TIA (OR 0.2 [0.1-0.4]) had a significant inverse association (all p<0.001). ST Elevation with no reciprocal depression and pericarditis/myocarditis were the most common ECG finding and etiology respectively.

Conclusion: Inappropriate for intervention CCL activation is not uncommon and should be closely monitored to maximize resource utilization. Females, African American patients with few or no risk factors and patients presenting ST elevation but no reciprocal depression constitute a population that may require attention.

Keywords: Acute coronary syndrome; Inappropriate cardiac catheterization laboratory activation; STEMI.

MeSH terms

  • Adult
  • Aged
  • Black or African American
  • Chi-Square Distribution
  • Coronary Angiography
  • Diagnostic Errors*
  • Electrocardiography
  • Female
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Odds Ratio
  • Ohio / epidemiology
  • Patient Selection
  • Percutaneous Coronary Intervention*
  • Predictive Value of Tests
  • Process Assessment, Health Care*
  • Retrospective Studies
  • Risk Assessment
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / ethnology
  • ST Elevation Myocardial Infarction / therapy*
  • Sex Factors
  • Time Factors
  • Time-to-Treatment*
  • Treatment Outcome
  • Unnecessary Procedures*