PMID- 27683739
OWN - NLM
STAT- MEDLINE
DCOM- 20170221
LR  - 20200825
IS  - 2972-4066 (Electronic)
IS  - 0304-4602 (Linking)
VI  - 45
IP  - 8
DP  - 2016 Aug
TI  - Impact of Direct Cardiovascular Laboratory Activation by Emergency Physicians on 
      False-Positive Activation Rates.
PG  - 351-6
AB  - INTRODUCTION: Door-to-balloon (DTB) time is critical to ST elevation myocardial 
      infarction (STEMI) patients' survival. Although DTB time is reduced with direct 
      cardiovascular laboratory (CVL) activation by emergency physicians, concerns 
      regarding false-positive activation remain. We evaluate false-positive rates 
      before and after direct CVL activation and factors associated with false-positive 
      activations. MATERIALS AND METHODS: This is a retrospective single centre study 
      of all emergency CVL activation 3 years before and after introduction of direct 
      activation in July 2007. False-positive activation is defined as either: 1) 
      absence of culprit vessel with coronary artery thrombus or ulceration, or 2) 
      presence of chronic total occlusion of culprit vessel, with no cardiac biomarker 
      elevations and no regional wall abnormalities. All false-positive cases were 
      verified by reviewing their coronary angiograms and patient records. RESULTS: A 
      total of 1809 subjects were recruited; 84 (4.64%) identified as false-positives. 
      Incidence of false-positive before and after direct activation was 4.1% and 5.1% 
      respectively, which was not significant (P = 0.315). In multivariate logistic 
      regression analysis, factors associated with false-positive were: female (odds 
      ratio (OR): 2.104 [1.247-3.548], P = 0.005), absence of chest pain (OR: 5.369 
      [3.024-9.531], P <0.0001) and presence of only left bundle branch block (LBBB) as 
      indication for activation (OR: 65.691 [19.870-217.179], P <0.0001). CONCLUSION: 
      Improvement in DTB time with direct CVL activation by emergency physicians is not 
      associated with increased false-positive activations. Factors associated with 
      false-positive, especially lack of chest pain or LBBB, can be taken into account 
      to optimise STEMI management.
FAU - Tay, Julian Ck
AU  - Tay JC
AD  - Department of Cardiology, National Heart Centre Singapore, Singapore.
FAU - Lun, Liou Wei
AU  - Lun LW
FAU - Liang, Zhong
AU  - Liang Z
FAU - Chua, Terrance Sj
AU  - Chua TS
FAU - Lim, Swee Han
AU  - Lim SH
FAU - Wong, Aaron Sl
AU  - Wong AS
FAU - Ong, Marcus Eh
AU  - Ong ME
FAU - Ho, Kay Woon
AU  - Ho KW
LA  - eng
PT  - Journal Article
PL  - Singapore
TA  - Ann Acad Med Singap
JT  - Annals of the Academy of Medicine, Singapore
JID - 7503289
SB  - IM
MH  - Bundle-Branch Block/epidemiology
MH  - *Cardiac Catheterization
MH  - Chest Pain/epidemiology
MH  - Coronary Angiography
MH  - Disease Management
MH  - *Emergency Medicine
MH  - Humans
MH  - Logistic Models
MH  - Multivariate Analysis
MH  - *Percutaneous Coronary Intervention
MH  - *Physicians
MH  - Retrospective Studies
MH  - ST Elevation Myocardial Infarction/diagnosis/epidemiology/*therapy
MH  - Sex Factors
MH  - Singapore/epidemiology
MH  - Time-to-Treatment
EDAT- 2016/09/30 06:00
MHDA- 2017/02/22 06:00
CRDT- 2016/09/30 06:00
PHST- 2016/09/30 06:00 [entrez]
PHST- 2016/09/30 06:00 [pubmed]
PHST- 2017/02/22 06:00 [medline]
PST - ppublish
SO  - Ann Acad Med Singap. 2016 Aug;45(8):351-6.