Abstract 20625: False Activation of the Emergency Department for Triaged Patients With Presumed STEMI is Associated With Worse Long Mortality

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Abstract

Introduction: The onus of facilitating timely reperfusion therapy among STEMI patients ultimately depends on the clinical evaluation and electrocardiographic (ECG) interpretation. False activation (FA) can potentially lead to inappropriate treatment and predispose to incremental treatment-related risks, but the evidence in this regard is lacking.

Methods: In this prospective observational study we analyzed the FA rate between 1/2005-12/2014 among 4123 consecutive presumed STEMI pts, managed within a regional STEMI reperfusion program in Central and Southern Illinois. The FA pts was defined as those not meeting the ECG, laboratory and coronary angiographic definition of STEMI. They were further classified as “inappropriately” triaged when retrospective review of the activating ECG showed no evidence of characteristic STEMI changes, or “appropriately” triaged when the activating ECG showed STEMI changes without a corresponding infarct related artery on the angiogram. Ten-year mortality was derived from the U.S. National Death Index, using a matching methodology with final death verification probabilistic score of 99.8%.

Results: Overall, 1006 (24%) pts had FA, 54% were “inappropriately” triaged. The FA rate among pts presenting to the tertiary hospital was 22% (45% inappropriate) and among transferred pts was 26% (58% inappropriate). The table compares clinical and outcome variables between the FA and STEMI-confirmed subgroups.

Conclusions: Patients triaged from ED with presumed STEMI and ultimately confirmed not to be experiencing acute MI are a high-risk population consisting of multiple co-morbidities with similar in-hospital, and higher post-discharge mortality compared to a STEMI-confirmed population. More than half of these FA pts are "inappropriately" triaged implying the urgency of care required rather than accuracy of diagnosis. This study emphasizes the need for monitoring FA as an important clinical and quality metric for STEMI care.

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