• Shariq Shamim, Justin McCrary, Lori Wayne, Matthew Gratton, and Douglas B Bogart.
• 1 Cardiology Fellow University of Missouri, Kansas City, USA ; 2 Quality Improvement Director, Cardiology Section Truman Medical Center, USA ; 3 Professor and Chief of the Emergency Department University of Missouri, Kansas City and Truman Medical Center, USA ; 4 Formerly Associate Professor of Medicine University of Missouri, Kansas City and Chief of Cardiology of Truman Medical Center (Retired), USA.
• Cardiovasc Diagn Ther. 2014 Jun 1; 4 (3): 215-23.

BackgroundPrompt reperfusion has been shown to improve outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) with a goal of culprit vessel patency in <90 minutes. This requires a coordinated approach between the emergency medical services (EMS), emergency department (ED) and interventional cardiology. The urgency of this process can contribute to inappropriate cardiac catheterization laboratory (CCL) activations.ObjectivesOne of the major determinants of inappropriate activations has been misinterpretation of the electrocardiogram (ECG) in the patient with acute chest pain.MethodsWe report the ECG findings for all CCL activations over an 18-month period after the inception of a STEMI program at our institution.ResultsThere were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation. The electrocardiographic abnormalities were particularly problematic in African-Americans with left ventricular hypertrophy.ConclusionsIn this single-center, prospective observational study, nearly half of the inappropriate STEMI activations were due to the misinterpretation of anterior ST-segment elevation and this finding was commonly seen in African-Americans with left ventricular hypertrophy.

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