An Evaluation of the Accuracy of Emergency Physician Activation of the Cardiac Catheterization Laboratory for Patients With Suspected ST-Segment Elevation Myocardial Infarction
Received 17 January 2009; received in revised form 11 June 2009 and 30 June 2009; accepted 6 August 2009. published online 23 September 2009. Corrected Proof
Study objective
Current recommendations indicate that emergency physicians should activate cardiac catheterization laboratory personnel by a single page for ST-segment elevation myocardial infarction (STEMI) patients. We assessed the accuracy of emergency physician cardiac catheterization laboratory activations, angiographic findings, outcomes, and treatment times among patients with and without STEMI.
Methods
We classified the appropriateness and outcomes of consecutive emergency physician STEMI pages between June 2006 and September 2008. Emergency physician activations of the cardiac catheterization laboratory were classified according to the findings of the initial ECG compared with cardiology interpretation for the presence of STEMI and presence of coronary disease.
Results
During a 27-month period, emergency physician activation of the cardiac catheterization laboratory occurred 249 times. There were 188 (76%) patients with a true STEMI, of whom 13 did not receive emergency angiography. Of the 37 (15%) patients who had ECG findings meeting STEMI criteria and who ultimately did not have myocardial necrosis and underwent emergency angiography, 12 had significant disease and 5 had revascularization performed. Eleven patients had ECGs concerning for but not meeting STEMI criteria; all had emergency angiography (n=11) or received a diagnosis of non-STEMI (n=6). Only 13 patients were considered as having received unnecessary cardiac catheterization laboratory activations (5.2%) in which emergency angiography was not performed and myocardial infarction was excluded.
Conclusion
A significant number of emergency physician STEMI cardiac catheterization laboratory activations are for patients who did not meet standard STEMI criteria. However, most had ECG findings and symptoms that lead to emergency angiography, had significant disease, or were diagnosed with non-STEMI. Only a small percentage of patients received unnecessary cardiac catheterization laboratory activations. Our findings support current recommendations for emergency physician cardiac catheterization laboratory activation for potential STEMI patients.
aDepartment of Internal Medicine, Division of Cardiology, Virginia Commonwealth University Health System, Richmond, VA.
bthe Department of Emergency Medicine, Virginia Commonwealth University Health System, Richmond, VA.
cthe Office of Performance Improvement Virginia Commonwealth University Health System, Richmond, VA
Address for correspondence: Michael C. Kontos, MD, Room 285 Gateway Building, Second Floor, PO Box 980051, 1200 E Marshall St, Richmond, VA 23298-0051; 804-828-9989, fax 804-828-3544
Supervising editor: Deborah B. Diercks, MD
Author contributions: M. C. Kontos concieved of the study and wrote the initial article. M. C. Kontos, M. C. Kurz, CSR, SEJ, LK, and JPO assisted in data collection. M. C. Kontos, M. C. Kurz, CSR, SEJ, LK, JPO, and GWV assisted in data analysis and contributed to the revisions. M. C. Kontos takes responsibility for the paper as a whole.
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ABSTRACT