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Patients presenting with ST elevation myocardial infarction (STEMI) benefit from primary percutaneous coronary intervention (PCI) if performed in a timely manner. Inappropriate activation (IA) of the cardiac catheterization laboratory is associated with significant time and financial costs. Patient level predictors of IA have not been well-characterized. The objective of this study was to determine predictors of IA in patients activated for code STEMI.
We retrospectively analyzed a cohort of 396 consecutive patients who were activated for code STEMI from January 2009 through April 2011 at a large, urban teaching hospital. Those who underwent emergent coronary angiography (with or without PCI) were categorized as having appropriate activation (n=228). Patients for whom code STEMI activation was subsequently cancelled and did not undergo emergent coronary angiography were categorized as inappropriate activation (n=168). Both groups were compared and predictors for IA were determined using multivariate logistic regression analysis.
IA occurred in 42% of patients activated for code STEMI. Mean age, gender distribution, and history of prior myocardial infarction were similar between the groups. Body mass index < 18.5, use of self-transport to the emergency department, initial complaint, recent cocaine use, history of congestive heart failure, and history of atrial fibrillation were significantly between the two groups. Independent predictors for IA included age ≤ 35 years (odds ratio [OR], 4.85; 95% CI, 1.18-19.96; p=0.03), body mass index <18.5 (OR, 15.91; 95% CI, 5.38-47.07; p<0.0001), absence of both chest pain and shortness of breath at presentation (OR, 3.21; 95% CI, 1.79-5.76; p<0.0001), recent cocaine use (OR, 5.01; 95% CI, 1.19-10.12; p=0.02), history of congestive heart failure (OR, 3.59; 95% CI, 1.58-8.13; p=0.002), and history of atrial fibrillation (OR, 3.47; 95% CI, 1.19-10.12; p=0.02).
Multiple patient-level characteristics were associated with IA of the cardiac catheterization laboratory. Younger age, absence of both chest pain and shortness of breath, recent cocaine use, and history of heart failure and atrial fibrillation were independent predictors of IA.