False-Positive Cardiac Cath Lab Activations Common
Emphasis on rapid door-to-balloon times for STEMI may have unintended consequences
TUESDAY, Dec. 18 (HealthDay News) -- Between 9 to 14 percent of all cardiac catheterization laboratory activations in a regional ST-segment elevation myocardial infarction (STEMI) network are false positives, where no culprit coronary lesion is identified and/or cardiac biomarkers are negative, according to research published in the Dec. 19 issue of the Journal of the American Medical Association.
David M. Larson, M.D., of Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital in Minneapolis, and colleagues examined data from 1,345 patients with suspected STEMI presenting to a 30-hospital regional network, where electrocardiographic findings led to pre-transfer activation of a catheterization laboratory for percutaneous coronary intervention at a tertiary cardiovascular center. False-positive catheterizations were defined by three criteria: lack of culprit lesion, absence of coronary artery disease, and negative cardiac biomarker results.
Of the 1,335 patients with suspected STEMI treated by angiography, no culprit lesion was detected in 14 percent, no significant coronary artery disease was detected in 9.5 percent, and negative cardiac biomarkers were found in 11.2 percent. Mortality rates at 30 days were 2.7 percent in patients without a culprit lesion versus 4.6 in patients with a causative lesion.
"In the setting of increased emphasis on rapid door-to-balloon times, the consequences of false-positive catheterization laboratory activation need to be considered," the authors write. False-positive catheterization laboratory activation may be another quality metric to monitor for a STEMI program."