Burlacu Alexandru, Tinica Grigore, Artene Bogdan, Simion Paul, Savuc Diana, Covic Adrian
Department of Interventional Cardiology, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania.
Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania.
Emerg Med Int. 2020 Jul 20;2020:9839281. doi: 10.1155/2020/9839281. eCollection 2020.
. Inappropriate cardiac catheterization lab activation together with false-positive angiographies and no-culprit found coronary interventions are now reported as costly to the medical system, influencing STEMI process efficiency. We aimed to analyze data from a high-volume interventional centre (>1000 primary PCIs/year) exploring etiologies and reporting characteristics from all "blank" coronary angiographies in STEMI.
In this retrospective observational single-centre cohort study, we reported two-year data from a primary PCI registry (2035 patients). "Angio-only" cases were assigned to one of these categories: (a) Takotsubo syndrome; (b) coronary embolisation; (c) myocardial infarction with nonobstructive coronary arteries; (d) myocarditis; (e) CABG-referred; (f) normal coronary arteries (mostly diagnostic errors); and (g)others (refusals and death prior angioplasty). Univariate analysis assessed correlations between each category and cardiovascular risk factors.
412 STEMI patients received coronary angiography "only," accounting for 20.2% of cath lab activations. Barely 77 patients had diagnostic errors (3.8% from all patients) implying false-activations. 40% of "angio-only" patients (n = 165) were referred to surgery due to severe atherosclerosis or mechanical complications. Patients with diagnostic errors and normal arteries displayed strong correlations with all cardiovascular risk factors. Probably, numerous risk factors "convinced" emergency department staff to call for an angio.
STEMI network professionals often confront with coronary angiography "only" situations. We propose a classification according to etiologies. Next, STEMI guidelines should include audit recommendations and specific thresholds regarding "angio-only" patients, with specific focus on MINOCA, CABG referrals, and diagnostic errors. These measures will have a double impact: a better management of the patient, and a clearer perception about the usefulness of the investments.
目前有报道称，不适当的心脏导管实验室激活，以及血管造影假阳性和未发现罪犯病变的冠状动脉介入治疗对医疗系统成本高昂，影响ST段抬高型心肌梗死（STEMI）的治疗流程效率。我们旨在分析一家高容量介入中心（每年>1000例直接经皮冠状动脉介入治疗[PCI]）的数据，探讨STEMI中所有“空白”冠状动脉造影的病因及报告特征。
在这项回顾性观察性单中心队列研究中，我们报告了来自直接PCI注册系统的两年数据（2035例患者）。“仅血管造影”病例被归入以下类别之一：（a）应激性心肌病；（b）冠状动脉栓塞；（c）非阻塞性冠状动脉心肌梗死；（d）心肌炎；（e）冠状动脉旁路移植术（CABG）转诊；（f）冠状动脉正常（大多为诊断错误）；（g）其他（拒绝治疗及血管成形术前死亡）。单因素分析评估了每个类别与心血管危险因素之间的相关性。
412例STEMI患者仅接受了冠状动脉造影，占导管实验室激活病例的20.2%。仅有77例患者存在诊断错误（占所有患者的3.8%），意味着存在假激活情况。40%的“仅血管造影”患者（n = 165）因严重动脉粥样硬化或机械并发症而被转诊至外科手术。诊断错误和冠状动脉正常的患者与所有心血管危险因素均呈现出强相关性。可能是众多危险因素“说服”了急诊科工作人员要求进行血管造影检查。
STEMI网络专业人员经常面临“仅冠状动脉造影”的情况。我们建议根据病因进行分类。接下来，STEMI指南应纳入关于“仅血管造影”患者的审核建议和特定阈值，尤其关注心肌梗死伴非阻塞性冠状动脉病变（MINOCA）、CABG转诊和诊断错误。这些措施将产生双重影响：更好地管理患者，以及更清晰地认识投资的效用。
