TY - JOUR
T1 - Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation
AU - Patel, Apurva
AU - Parikh, Roosha
AU - Poddar, Kanhaiya L.
AU - Ellis, Stephen G.
AU - Tuzcu, E. Murat
AU - Kapadia, Samir R.
N1 - Publisher Copyright:
© 2016 Elsevier Inc.
PY - 2015/12/10
Y1 - 2015/12/10
N2 - Background Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤ 90 min 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.
AB - Background Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤ 90 min 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.
KW - Acute coronary syndrome
KW - Inappropriate cardiac catheterization laboratory activation
KW - STEMI
UR - https://www.scopus.com/pages/publications/84963626868
U2 - 10.1016/j.carrev.2016.03.015
DO - 10.1016/j.carrev.2016.03.015
M3 - Article
C2 - 27150501
AN - SCOPUS:84963626868
SN - 1553-8389
VL - 17
SP - 219
EP - 224
JO - Cardiovascular Revascularization Medicine
JF - Cardiovascular Revascularization Medicine
IS - 4
ER -