Key Points
- To identify electrocardiographic patterns and clinical determinants leading to inappropriate cardiac catheterization laboratory activation for suspected ST-segment elevation myocardial infarction.
- Single-center prospective observational study evaluating all cardiac catheterization laboratory activations during an 18-month period following the implementation of a institutional STEMI program.
- Analyzed clinical presentations and electrocardiograms (ECGs) of consecutive patients to determine the primary causes of non-STEMI activations.
- A total of 139 activations occurred over the 18-month period, comprising 77 confirmed STEMI diagnoses (55.4%) and 62 inappropriate non-STEMI activations (44.6%).
- Misinterpretation of the presentation ECG combined with atypical symptoms drove inappropriate activations, with anterior ST-segment elevation accounting for 45% of false alerts.
- Electrocardiographic misinterpretation occurred predominantly among African-American patients with underlying left ventricular hypertrophy.
Structured PICO
PPopulation139 cardiac catheterization laboratory activations over an 18-month period at a single institution
OOutcomeInappropriate cardiac catheterization laboratory activations (no STEMI confirmed)
Nearly half of inappropriate STEMI activations were due to misinterpretation of anterior ST-segment elevation, commonly seen in African-Americans with left ventricular hypertrophy.