Among patients with cancelled STEMI alerts, 4.2% had an undetected acute coronary occlusion, which was associated with a non-significant trend toward higher in-hospital mortality (10.7% vs 7.7%, p=0.5).
Observational (n=665)
No
What are the clinical characteristics, ECG patterns, and outcomes of patients with cancelled STEMI alerts who have an undetected acute coronary occlusion?
A small but clinically important proportion (4.2%) of cancelled STEMI alerts have undetected acute coronary occlusion, often presenting with subtle ECG changes and higher baseline cardiovascular risk.
Absolute Event Rate: 10.7% vs 7.7%
p-value: p=0.5
Abstract Background False positive activations in ST-segment elevation myocardial infarction (STEMI) networks lead to unnecessary use of catheterization laboratories (cathlabs) and misallocation of healthcare resources, increasing operational strain. To prevent cathlab overcrowding, cancelling STEMI alerts after telematic evaluation is a common practice to avoid unnecessary procedures, but this approach carries the risk of missing patients with acute coronary occlusion who require urgent revascularization. Purpose This study aimed to characterize patients whose STEMI alerts were cancelled before transfer, identify those with missed acute coronary occlusion, and describe the clinical characteristics and ECG patterns of this group. Methods This prospective, observational, single-centre study included patients initially identified for STEMI alert activation but later cancelled following a multidisciplinary telematic decision via the ODISEA digital health platform. Patients were classified based on coronary angiography findings into two groups: acute coronary occlusion (TIMI 0–1 flow with thrombotic appearance) and cancelled patients without acute occlusion. We compared these groups in terms of baseline characteristics, ECG findings, angiographic data, and in-hospital mortality. Results Among 665 patients with cancelled STEMI alerts (29.4% of all STEMI activations), 28 (4.2%) had an undetected acute coronary occlusion. These patients had a higher prevalence of hypertension (78.6% vs. 60.3%; p = 0.03), diabetes mellitus (46.4% vs. 28.4%; p = 0.03), and prior coronary artery bypass grafting (10.7% vs. 2.5%; p = 0.01) compared to the remaining cancelled patients. Electrocardiographic patterns in acute occlusion cases showed inframillimetric (1mm) ST-segment elevation in 67.8% and ST-segment depression in 25%. Additionally, 3.6% had left bundle branch block (LBBB) with positive Sgarbossa criteria, and 3.6% had right bundle branch block (RBBB) with concurrent ST-segment elevation. Among patients with acute coronary occlusion, the most frequently affected artery was the left anterior descending (LAD) artery. Despite the need for urgent intervention, 25% did not undergo revascularization, including 14.3% who experienced PCI failure. The overall in-hospital mortality was 7.8%, with a trend toward higher mortality in the acute coronary occlusion group (10.7%) compared to cancelled patients without occlusion (7.7%), but this difference was not statistically significant (p = 0.5). Conclusion Among cancelled cases, 4.2% had an undetected acute coronary occlusion, with a higher prevalence of cardiovascular risk factors and subtle ECG abnormalities, particularly inframillimetric ST-segment elevation and ST-segment depression. The LAD artery was the most frequently affected, and 25% of cases did not undergo revascularization. Mortality was high in the acute occlusion group but was not statistically significant compared to the remaining cancelled patients.Demographic and clinical characteristics Angiographic findings
Martinez et al. (Sat,) conducted a observational in Cancelled ST-segment elevation myocardial infarction (STEMI) alerts (n=665). Undetected acute coronary occlusion vs. Cancelled patients without acute occlusion was evaluated on In-hospital mortality (p=0.5). Among patients with cancelled STEMI alerts, 4.2% had an undetected acute coronary occlusion, which was associated with a non-significant trend toward higher in-hospital mortality (10.7% vs 7.7%, p=0.5).