In Reply: We agree with Dr Yan and colleagues that false-positive activation of the cardiac catheterization laboratory may be entirely appropriate. We also agree that accurate interpretation of the ECG is a critical issue and that ongoing quality improvement efforts should be in place to avoid unnecessary catheterization laboratory activation.
Yan et al point out that the prevalence of clearly inappropriate referrals for primary percutaneous coronary intervention was lower than in previous studies. This is likely to be related to the extensive initial training at each referral site as well as a quality improvement program that provides immediate feedback to the emergency physician for each individual case, allowing angiographic correlation with the clinical and ECG findings. In addition, the false-positive cardiac catheterization activation range of 9% to 14% is based primarily on the emergency department physician diagnosis. Depending on the algorithm used, prehospital diagnosis and triage may be associated with a higher prevalence of unnecessary catheterization laboratory activations.
Larson DM, Sharkey SW, Henry TD. Misinterpretation of Electrocardiograms and Cardiac Catheterization Laboratory Activations—Reply. JAMA. 2008;299(16):1897-1898. doi:10.1001/jama.299.16.1897-b