Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry

Alexandru Burlacu; Grigore Tinica; Bogdan Artene; Paul Simion; Diana Savuc; Adrian Covic

doi:10.1155/2020/9839281

Peculiarities and Consequences of Different Angiographic Patterns of STEMI Patients Receiving Coronary Angiography Only: Data from a Large Primary PCI Registry

Emerg Med Int. 2020 Jul 20:2020:9839281. doi: 10.1155/2020/9839281. eCollection 2020.

Authors

Alexandru Burlacu¹, Grigore Tinica², Bogdan Artene³, Paul Simion³, Diana Savuc³, Adrian Covic^{4

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Affiliations

¹ Department of Interventional Cardiology, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania.
² Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine, Iasi, Romania.
³ Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania.
⁴ Nephrology Clinic, Dialysis and Renal Transplant Center, "C.I. Parhon" University Hospital, Iasi, Romania.
⁵ "Grigore T. Popa" University of Medicine, Iasi, Romania.
⁶ The Academy of Romanian Scientists (AOSR), Bucharest, Romania.

Abstract

Background. 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.

Methods: 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.

Results: 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.

Conclusions: 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.