The appropriateness of single page of activation of the cardiac catheterization laboratory by emergency physician for patients with suspected ST-segment elevation myocardial infarction: a cohort study

All patients with emergency physician CCL activations between August 2009 and April 2011 were included in the study. False positive cases were defined according to ECG criteria and cardiologists' reviews of patients' initial clinical information.ED physicians used a STEMI page to activate the CCL 117 times. According to reviews by cardiologists, this activation was appropriate 89.8% of the time (in 105/117 cases). Truly unnecessary activation (i.e., cases in which STEMI was not identified by the cardiologists, no clear culprit coronary artery was present, no significant coronary artery disease and cardiac biomarkers were negative) occurred 5.1% of the time (in 6/117 cases).CCL activation was appropriate for most patients and was unnecessary in a relatively small percentage of cases. This result supports the current recommendation for CCL activation by emergency physicians. Such early activation is a key strategy in the reduction of door-to-balloon time.Early intervention is fundamental in the treatment of ST-segment elevation myocardial infarction (STEMI), and the timely restoration of coronary blood flow can reduce mortality [1-3]. According to the current American Heart Association (AHA) guidelines for reperfusion, a patient with STEMI should receive fibrinolytics within 30 minutes of arrival (for a 30-minute "door-to-drug" interval) or percutaneous coronary intervention (PCI) within 90 minutes of arrival (for a 90-minute "door-to-balloon" interval) [4]. Several strategies to reduce door-to-balloon time have been recommended, including allowing emergency physicians to bypass routine cardiology consultations and directly activate the cardiac catheterization laboratory (CCL) [5].If the proportion of false positive CCL activations is acceptably low, this strategy may be the best way to reduce door-to-balloon time. The AHA's STEMI guidelines recommend that emergency physicians make a decision regarding reperfusion therapy within 10 minutes of interpreting a patient's