title: Incidence and characteristics of inappropriate and false-positive cardiac catheterization laboratory activations in a regional primary percutaneous coronary intervention program.
abstract: BACKGROUND
  The implementation of regional primary percutaneous coronary intervention (PCI) programs has been critical in achieving timely intervention in patients with ST-segment elevation myocardial infarction (STEMI). However, 1 consequence has been inappropriate and false-positive cardiac catheterization laboratory (CCL) activations where either angiography is cancelled or no culprit lesion is found, respectively.
  
  
  METHODS
  We performed a retrospective cohort study of 1,391 patients referred for primary PCI to a single academic center from November 2007 to August 2013. Our purpose was to determine the incidence and characteristics of inappropriate and false-positive CCL activations by emergency departments (EDs) or emergency medical services (EMS), and the effect of a quality improvement (QI) initiative to reduce such events implemented during this period.
  
  
  RESULTS
  During the study period, there were 37 (2.7%) inappropriate and 206 (14.8%) false-positive CCL activations. There was no difference between the ED and EMS rates of inappropriate activation (2.1% vs 3.8%, P = .06). Among patients who proceeded to angiography, the false-positive rate for ED CCL activation was 16.9% compared to 11.5% for EMS (P = .01). Although there was no difference comparing inappropriate activation or false-positive rates before and after the QI initiative (P = .22), we observed an encouraging year-to-year trend.
  
  
  CONCLUSIONS
  Emergency department activation of the CCL is associated with a higher false-positive rate than activation by EMS. Further QI efforts are required to improve communication between interventional cardiologists, emergency physicians, and paramedics to improve the specificity of CCL activation while taking care not to sacrifice sensitivity and rapidity of diagnosis.
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Lu
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Akshay
authors.initials: A
authors.lastname: Bagai
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Buller
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Asim
authors.initials: A
authors.lastname: Cheema
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: John
authors.initials: J
authors.lastname: Graham
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Kutryk
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Jo-Ann
authors.initials: JA
authors.lastname: Christie
authors.affiliation: St Michael's Hospital, Toronto, ON, Canada. Electronic address: famn@smh.ca.
authors.forename: Neil
authors.initials: N
authors.lastname: Fam
mesh_terms: D000368:Aged; D006328:Cardiac Catheterization / Q000706:statistics & numerical data*; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005189:False Positive Reactions; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D062645:Percutaneous Coronary Intervention / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D019564:Unnecessary Procedures / Q000706:statistics & numerical data*