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April 23 2008

Misinterpretation of Electrocardiograms and Cardiac Catheterization Laboratory Activations—Reply

JAMA. 2008;299(16):1897-1898. doi:10.1001/jama.299.16.1898-a

In Reply: The contention by Dr Yan and colleagues that not all false-positive catheterization laboratory activations are undesirable or unavoidable is well founded. The study by Dr Larson and colleagues1 found that these events occurred for a wide range of reasons. It is likely that some of these patients derived meaningful benefits such as diagnostic clarity from angiography. Furthermore, decisions to pursue angiography for suspected STEMI using percutaneous strategies, even if “clearly inappropriate,” may pose substantially lower risks to patients than the overuse of fibrinolysis. These factors, in conjunction with the knowledge that increasing the specificity of triage risks lower sensitivity, suggest that efforts to eliminate false-positive laboratory activations in systems delivering percutaneous coronary intervention would be logistically daunting and may adversely affect aggregate patient outcomes. However, the individual analysis of the reasons for possible false-positive laboratory activations would identify potential opportunities for improvement.