Background:
To decrease door to balloon time (D2B) for STEMI patients (pts), it is recommended that the Emergency Department (ED) activate the cardiac catheterization laboratory (Cath Lab) directly through a simultaneous group STEMI page that includes the Cath Lab staff and interventionalist. Anecdotal evidence suggests that inappropriate activation is infrequent; however quantitative data is lacking.
Methods
: We assessed the frequency and outcomes of ED STEMI pages to determine the number who had a true STEMI, those who had ECG findings worrisome for but not meeting STEMI criteria, and the frequency of MI. A pt was considered a “false alarm” if emergent cath was not done and MI was excluded. Angiographic findings and outcomes were also evaluated.
Results:
Over a 1 year period, ED activation of the Cath Lab via the STEMI page occurred 98 times. There were 61 (62%) pts with a true STEMI, of whom only two did not have an emergent cath (2 not done because of sepsis and acute stroke)(Table
). A total of 32 (33%) pts had ECG findings concerning for but not meeting STEMI criteria, of whom 31 (97%) underwent emergent cath, with PCI performed in 10 (32%). In 5 pts (5%), the Cath Lab was de-activated after further assessment, and would have been considered “false alarms”.
Conclusions:
A significant number of ED STEMI Cath Lab activations are for pts who do not meet standard STEMI criteria. However, most have suggestive ECG findings benefiting from emergent angiography, and have either significant disease, undergo PCI, and/or are diagnosed with non-STEMI. Only a small percentage (5%) are clear “false alarms. This data further support current recommendations for ED Cath Lab activation for potential STEMI pts.
FALSE ACTIVATION OF CARDIAC CATHETERIZATION LABORATORY BY EMERGENCY DEPARTMENT PHYSICIANS IN THE SETTING OF ACUTE ST ELEVATION MI AND IMPLICATION ON DOOR-TO-BALLOON TIME
