title: Frequency and factors associated with inappropriate for intervention cardiac catheterization laboratory activation.
abstract: BACKGROUND
  Current guidelines emphasize timely coronary intervention with a door to balloon time of ≤90min for favorable survival impact after STEMI. Efforts to achieve these targets may result in unnecessary emergent angiography for inappropriate activations.
  
  
  OBJECTIVE
  Evaluate the frequency, trend and factors which are significantly associated with inappropriate for intervention cardiac catheterization laboratory (CCL) activation.
  
  
  METHODS
  We analyzed 1764 consecutive emergent CCL activation for possible ST segment elevation myocardial infarction (STEMI) between 7/2005 and 8/2013. Inappropriate for intervention activation was defined as negative STEMI (incorrect diagnosis: insignificant coronary lesion, not requiring any intervention) and inappropriate patients (true STEMI but poor CCL candidacy).
  
  
  RESULTS
  Inappropriate for intervention CCL activation occurred in 317 patients (17.9%): 292 incorrect diagnosis (negative STEMI diagnosis), 25 inappropriate patients, with no difference in the frequency based on time of the day (18.6% regular hours vs. 17.6% off-hours, p=0.6). On multivariable analysis, female gender (OR 1.9 [1.2-3.0]), African American race (OR 1.9[1.3-2.7]), and prior coronary artery bypass graft surgery (OR 3.6 [2.3-5.5]) were significantly associated with incorrect diagnosis (negative STEMI diagnosis) (all p<0.005) and hyperlipidemia (OR 0.2 [0.1-0.3]), tobacco use (OR 0.2 [0.1-0.3]), and stroke/TIA (OR 0.2 [0.1-0.4]) had a significant inverse association (all p<0.001). ST Elevation with no reciprocal depression and pericarditis/myocarditis were the most common ECG finding and etiology respectively.
  
  
  CONCLUSIONS
  Inappropriate for intervention CCL activation is not uncommon and should be closely monitored to maximize resource utilization. Females, African American patients with few or no risk factors and patients presenting ST elevation but no reciprocal depression constitute a population that may require attention.
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Apurva
authors.initials: A
authors.lastname: Patel
authors.affiliation: Department of Internal Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Roosha
authors.initials: R
authors.lastname: Parikh
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Kanhaiya L
authors.initials: KL
authors.lastname: Poddar
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Ellis
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH.
authors.forename: E Murat
authors.initials: EM
authors.lastname: Tuzcu
authors.affiliation: Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH. Electronic address: kapadis@ccf.org.
authors.forename: Samir R
authors.initials: SR
authors.lastname: Kapadia
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003951:Diagnostic Errors; D004562:Electrocardiography; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D009820:Ohio / Q000453:epidemiology; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention; D011237:Predictive Value of Tests; D017064:Process Assessment, Health Care; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000208:ethnology / Q000628:therapy*; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D019564:Unnecessary Procedures
keywords: Acute coronary syndrome; Inappropriate cardiac catheterization laboratory activation; STEMI