May 7th, 2012
All Dressed Up and No Place to Go: False-Positive Activation of the Cath Lab for Primary PCI
Primary PCI is widely recognized as the best early option for patients with ST-segment elevation myocardial infarction (STEMI). However, efforts to deliver primary PCI to the broadest possible population inevitably result in an increased number of false-positive activations of the cardiac catheterization laboratory. Now, a new study published in the Archives of Internal Medicine finds that the rate of false-positive activations is higher than expected.
James McCabe and colleagues analyzed data from 411 STEMI activations at two primary PCI centers. More than one-third — 36% — were judged to be false-positive. Patients with high BMIs or with chest pain or pressure at presentation were less likely to have a false-positive activation. The following factors were independently associated with an increased risk for a false-positive STEMI activation:
- Left ventricular hypertrophy on ECG: adjusted odds ratio (AOR) 3.15, CI 1.55- 6.40, p=0.001
- History of coronary disease: AOR 1.93, CI 1.04-3.59, p=0.04
- History of illicit drug abuse: AOR 2.67, CI 1.13-6.26, p=0.02
While a certain percentage of false-positive STEMI activations are essential to ensuring adequate diagnostic sensitivity, the point of equipoise between necessary diagnostic sensitivity and patient safety requires further investigation, particularly in light of increasing resource limitations.