title: The appropriateness of single page of activation of the cardiac catheterization laboratory by emergency physician for patients with suspected ST-segment elevation myocardial infarction: a cohort study.
abstract: BACKGROUND
  The early use of reperfusion therapy has a significant effect on the prognosis of patients with ST-segment elevation myocardial infarction (STEMI), and it is recommended that emergency department (ED) physicians activate the cardiac catheterization laboratory (CCL) as soon as possible to treat these patients. The aim of this study was to examine the appropriateness of emergency physician activation of the CCL for patients with suspected STEMI. Inappropriate activations (i.e., false positive activations) were identified according to a variety of criteria.
  
  
  METHODS
  All patients with emergency physician CCL activations between August 2009 and April 2011 were included in the study. False positive cases were defined according to ECG criteria and cardiologists' reviews of patients' initial clinical information.
  
  
  RESULTS
  ED physicians used a STEMI page to activate the CCL 117 times. According to reviews by cardiologists, this activation was appropriate 89.8% of the time (in 105/117 cases). Truly unnecessary activation (i.e., cases in which STEMI was not identified by the cardiologists, no clear culprit coronary artery was present, no significant coronary artery disease and cardiac biomarkers were negative) occurred 5.1% of the time (in 6/117 cases).
  
  
  CONCLUSIONS
  CCL activation was appropriate for most patients and was unnecessary in a relatively small percentage of cases. This result supports the current recommendation for CCL activation by emergency physicians. Such early activation is a key strategy in the reduction of door-to-balloon time.
authors.affiliation: Department of Emergency Medicine, College of Medicine, The Catholic University of Korea, Seoul Korea.
authors.forename: Soo Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Sang Hoon
authors.initials: SH
authors.lastname: Oh
authors.forename: Seung Pill
authors.initials: SP
authors.lastname: Choi
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.forename: Young Min
authors.initials: YM
authors.lastname: Kim
authors.forename: Chun Song
authors.initials: CS
authors.lastname: Youn
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D006328:Cardiac Catheterization; D016009:Chi-Square Distribution; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005189:False Positive Reactions; D005260:Female; D006747:Hospital Communication Systems; D006801:Humans; D007723:Korea; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome