Abstract 2809: Absence of Flow-Limiting Coronary Artery Disease Among Patients Undergoing Emergent Cardiac Catheterization For ST Segment Elevation Myocardial Infarction in the National Cardiovascular Data Registry CathPCI Registry: Implications for Primary Angioplasty Programs

Abstract

Background : Many hospitals have established primary angioplasty programs with a goal of providing consistently timely reperfusion for patients with suspected acute ST segment elevation myocardial infarction (STEMI). As the locus of control for activation of the cardiac catheterization laboratory moves from the cardiologist to the emergency department and even to pre-hospital activation by emergency medical services, concerns have been raised about ``false positive” activations of the primary angioplasty team, yet there has been little data on the frequency of this occurence. Objective : We sought to estimate how often flow-limiting coronary artery disease (CAD) was NOT found among patients undergoing emergent cardiac catheterization in a large multi-center registry. Methods and Results : The National Cardiovascular Data Registry (NCDR) CathPCI Registry is a cardiac catheterization and angioplasty quality improvement and outcomes database with over 800 participating institutions. Among 131,211 patients undergoing emergent or salvage coronary angiography from 1/1/2005 -12/31/2006, 9.8% had no lesions of ≥50% diameter stenoses in the major epicardial coronary arteries. No angiographically visualized coronary stenoses at all were reported in 5.2% of these cases. Detailed data were not readily available on whether the primary indication for the procedure was suspected acute STEMI vs. other reasons such as hemodynamic instability or refractory arrhythmia. Conclusions : Among patients undergoing emergent or salvage diagnostic catheterizations nationwide in the NCDR CathPCI Registry, finding NO angiographically-apparent flow-limiting CAD was uncommon (<10%). While no clinical finding or test will perfectly discriminate STEMI from ``STEMI mimics”, current clinical practice appears to activate primary angioplasty teams with reasonable specificity.