Author + information
- Kamala Ramya Kallur,
- Pragya Ranjan,
- Jasjit Bhinder,
- Ashish Correa and
- Jacqueline Tamis-Holland
Background: Time to reperfusion is a major determinant of outcome among patients with ST elevation infarction (STEMI). Unfortunately, efforts to rapidly triage these patients can result in false positive activation (FPA) of the cardiac catheterization laboratory for some patients without true STEMI.
Methods: We studied the rate of FPA resulting in emergency referral for coronary angiography (CAG), and the potential consequences of FPA, at two hospitals. We examined a sample of patients referred for emergency CAG for a suspected STEMI from January 2012 until March 2015. A patient was considered to have a “False Positive STEMI” (FP-STEMI) if CAG did not show evidence of obstructive coronary artery disease (defined as greater than 50% obstruction). Patients with cardiogenic shock and post-cardiac arrest were excluded.
Results: Among 485 patients referred to the cardiac catheterization laboratory for suspected STEMI, 408 had true STEMI. The remaining 77 patients (15.8%) were considered to be a FP- STEMI and were included in the analysis: Mean age 56 ± 14 years, 72% male, 8% with prior MI and 9% with cocaine use. Of these 77 patients, 5 (6.5%) had other life-threatening diagnoses including pulmonary embolism and aortic dissection. Other post procedure diagnoses included Takatsubo, vasospasm, myocarditis, pericarditis, arrythmias and acute GI pathology. A total of 7 patients (9%) had transient kidney injury. There were no other post-procedure complications. The total additional cost to the two hospitals for FP-STEMI was estimated to be $21523 at an average of $280 per patient.
Conclusions: Although the downstream effects to the individual patient are infrequent and the cost to the hospital is minor, FPA can lead to delayed recognition of other potentially life-threatening conditions. Hospitals need to remain diligent in thoroughly triaging patients with suspected STEMI, to optimize reperfusion times for the large majority of patients with true STEMIs while minimizing the number of FPSTEMIs.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Revascularization and Myocardial Preservation in Acute and Stable Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1165-310
- 2017 American College of Cardiology Foundation