Key result
Chest pain with ST elevation linked to ~66% lower mortality despite higher acute revascularization rates.
Why the study?
Emergent cardiac catheterization laboratory activation often yields false positives and is sometimes initiated without both chest pain and ST elevation, but the associated likelihood of acute revascularization and mortality was not quantified.
Does the combination of chest pain and ST elevation predict the likelihood of acute revascularization and hospital mortality in patients with cardiac catheterization laboratory activation?
Observational (n=1,621)
Yes
Does the combination of chest pain and ST elevation predict the likelihood of acute revascularization and hospital mortality in patients with cardiac catheterization laboratory activation?
Patients undergoing cath lab activation without both chest pain and ST elevation are less likely to have an acute MI or receive revascularization, but have a significantly higher hospital mortality, primarily from non-coronary causes.
Answers are grounded in this paper and cite their sources.
Highlights higher mortality without both chest pain and ST elevation; hypothesis-generating for refined activation criteria in cohort data.
BACKGROUND: Emergent cardiac catheterization laboratory activation (CCLA) for patients with suspected ST-elevation myocardial infarction (STEMI) is employed to expedite acute revascularization (AR). The incidence of false-positive CCLA, in which AR is not performed, remains high. The combination of chest pain (CP) and electrocardiographic ST elevation (STE) are the hallmarks of STEMI. However, CCLA is sometimes initiated for patients lacking this combination. The study objective was to quantify the difference in likelihood of AR and mortality in patients with vs. without both CP and STE. METHODS: Retrospective analysis of 1621 consecutive patients for whom CCLA was initiated in a six-hospital network. We assessed the likelihood of acute myocardial infarction (AMI), presence of a culprit lesion (CL), performance of AR, and hospital mortality among patients with both CP and STE (+CP/+STE) compared with patients lacking one or both [non(CP/STE)]. RESULTS: 87.0% of patients presented with CP, 82.4% with STE, and 73.7% with both. Among +CP/+STE patients, AMI was confirmed in 90.4%, a CL in 88.9%, and AR performed in 83.1%. The corresponding values among non(CP/STE) patients were 35.8, 31.9, and 28.1%, respectively (P < 0.0001 for each). Nevertheless, mortality among non(CP/STE) patients was three-fold higher than in +CP/+STE patients (13.3% vs. 4.5%; P < 0.0001), with non-coronary deaths 24-fold more likely. CONCLUSION: Patients lacking the combination of CP and STE have a markedly lower likelihood of AMI and AR than +CP/+STE patients, but significantly higher mortality. Protocols aimed at rapid, focused evaluation of non(CP/STE) patients prior to CCLA are needed.
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Puleo et al. (2020) conducted an observational in Suspected ST-elevation myocardial infarction (STEMI) (n=1,621). Presence of both chest pain and ST elevation (+CP/+STE) vs. Absence of one or both [non(CP/STE)] was evaluated on Acute revascularization (AR) (p=<0.0001). Patients presenting with both chest pain and ST elevation had a higher likelihood of acute revascularization but lower mortality compared to those lacking one or both.
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