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April 23 2008

Misinterpretation of Electrocardiograms and Cardiac Catheterization Laboratory Activations

JAMA. 2008;299(16):1897-1898. doi:10.1001/jama.299.16.1897-a

To the Editor: In a prospective registry study of a regional ST-elevation myocardial infarction (STEMI) treatment program, Dr Larson and colleagues1 found that the “false-positive” rate of cardiac catheterization laboratory activation ranged from 9% to 11%, depending on the definition used. As pointed out by Dr Masoudi2 in the accompanying Editorial, some degree of false-positive laboratory activation may be inevitable. In particular, current guidelines recommend an immediate invasive strategy over fibrinolytic therapy when the diagnosis of STEMI is uncertain,3 especially among patients at high risk of bleeding and intracranial hemorrhage. Furthermore, ancillary diagnostic tests such as echocardiography may have limited utility in differentiating between previous and acute myocardial infarction. Thus, to a certain extent, false-positive activation of cardiac catheterization laboratory may be entirely appropriate. This concept may be akin to the use of exploratory laparotomy for suspected appendicitis, where some false-positive results are generally accepted given the potentially dire consequences of not identifying all patients with appendicitis.