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Unnecessary Catheterization Laboratory Activation: The Cost of Doing Business?
In a regional STEMI management system, "false-positive" activation of the cath lab occurred in about 1 in 10 cases.
National efforts to improve the care of patients with ST-segment-elevation MI have focused on reducing door-to-balloon times for primary percutaneous coronary intervention. However, concerns have been raised about inappropriate catheterization laboratory activations in programs designed to achieve this goal. To determine the prevalence and etiology of "false-positive" activation of the cath lab, investigators analyzed prospective registry data from a regional system that provides for transfer of patients with STEMI from 30 community hospitals to a tertiary cardiac center in Minnesota. The main outcome of interest was false-positive cath lab activation, defined by one of three criteria: no culprit lesion, no significant coronary artery disease, and negative findings on cardiac biomarker tests.
A total of 1335 patients underwent angiography from March 2003 to November 2006. Of these, no culprit lesion was found in 14.0%, 9.5% had no significant CAD, and fully 11.2% had negative test results for biomarkers. By these measures, about 1 in 10 cath lab referrals were false positive. False-positive cath lab activation was especially prevalent in the treatment of women (as determined by no culprit lesion and no CAD), patients with new left bundle branch block, and those with previous MI or coronary artery bypass surgery.
Comment: In this tertiary care, referral-based system, the rate of false-positive catheterization laboratory activation was about 1 in 10 cases. Whether these results are generalizable to other institutions and settings remains to be determined. As noted in an accompanying editorial, true quality assessment of primary PCI delivery systems should go beyond door-to-balloon time to include appropriate patient selection and outcomes measures. For now, however, a small number of unnecessary catheterizations is a risk that should not outweigh the benefits of early intervention in the development of system-wide programs to improve STEMI treatment.
Published in Journal Watch Cardiology December 18, 2007
Citation(s):
Larson DM et al. "False-positive" cardiac catheterization laboratory activation among patients with suspected ST-segment elevation myocardial infarction. JAMA 2007 Dec 19; 298:2754.
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- Medline abstract (Free)
Masoudi FA. Measuring the quality of primary PCI for ST-segment elevation myocardial infarction. JAMA 2007 Dec 19; 298:2790.
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- Medline abstract (Free)