{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T17:38:11Z","timestamp":1781890691111,"version":"3.54.5"},"reference-count":38,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>\n              Prehospital ECG-based cardiac catheterization laboratory (CCL) activation for ST-segment\u2013elevation myocardial infarction reduces door-to-balloon times, but CCL cancellations (CCL\n              <jats:sup>X<\/jats:sup>\n              ) remain a challenging problem. We examined the reasons for CCL\n              <jats:sup>X<\/jats:sup>\n              , clinical characteristics, and outcomes of patients presenting as ST-segment\u2013elevation myocardial infarction activations who receive emergent coronary angiography (EA) compared with CCL\n              <jats:sup>X<\/jats:sup>\n              .\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and Results:<\/jats:title>\n            <jats:p>\n              We reviewed all consecutive CCL activations between January 1, 2012, and December 31, 2014 (n=1332). Data were analyzed comparing 2 groups stratified as EA (n=466) versus CCL\n              <jats:sup>X<\/jats:sup>\n              (n=866; 65%). Reasons for CCL\n              <jats:sup>X<\/jats:sup>\n              included bundle branch block (21%), poor-quality prehospital ECG (18%), non\u2013ST-segment\u2013elevation myocardial infarction ST changes (18%), repolarization abnormality (13%), and arrhythmia (8%). A multivariate logistic regression model using age, peak troponin, and initial ECG findings had a high discriminatory value for determining EA versus CCL\n              <jats:sup>X<\/jats:sup>\n              (C statistic, 0.985). CCL\n              <jats:sup>X<\/jats:sup>\n              subjects were older and more likely to be women, have prior coronary artery bypass grafting, or a paced rhythm (\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001 for all). All-cause mortality did not differ between groups at 1 year or during the study period (mean follow-up, 2.186\u00b11.167 years; 15.8% EA versus 16.2% CCL\n              <jats:sup>X<\/jats:sup>\n              ;\n              <jats:italic>P<\/jats:italic>\n              =0.9377). Cardiac death was higher in the EA group (11.8% versus 3.0%;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.0001). After adjusting for clinical variables associated with survival, CCL\n              <jats:sup>X<\/jats:sup>\n              was associated with an increased risk for all-cause mortality during the study period (hazard ratio, 1.82; 95% CI, 1.28\u20132.59;\n              <jats:italic>P<\/jats:italic>\n              =0.0009).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>\n              In this study, prehospital ECG without overreading or transmission lead to frequent CCL\n              <jats:sup>X<\/jats:sup>\n              . CCL\n              <jats:sup>X<\/jats:sup>\n              subjects differ with regard to age, sex, risk factors, and comorbidities. However, CCL\n              <jats:sup>X<\/jats:sup>\n              patients represent a high-risk population, with frequently positive cardiac enzymes and similar short- and long-term mortality compared with EA. Further studies are needed to determine how quality improvement initiatives can lower the rates of CCL\n              <jats:sup>X<\/jats:sup>\n              and influence clinical outcomes.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circoutcomes.117.004464","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T10:17:06Z","timestamp":1537093026000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":18,"title":["Cancellation of the Cardiac Catheterization Lab After Activation for ST-Segment\u2013Elevation Myocardial Infarction"],"prefix":"10.1161","volume":"11","author":[{"given":"David C.","family":"Lange","sequence":"first","affiliation":[{"name":"The Permanente Medical Group, Kaiser Permanente Santa Clara Medical Center, Santa Clara, CA (D.C.L.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Conte","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Effie","family":"Pappas-Block","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Hildebrandt","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mamoo","family":"Nakamura","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raj","family":"Makkar","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saibal","family":"Kar","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Torbati","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joel","family":"Geiderman","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"McNeil","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine (S.T., J.G., N.M.), Cedars-Sinai Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bojan","family":"Cercek","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven W.","family":"Tabak","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Rokos","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, UCLA Olive View Medical Center, Los Angeles, CA (I.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy D.","family":"Henry","sequence":"additional","affiliation":[{"name":"Cedars-Sinai Heart Institute (S.C., E.P.-B., D.H., M.N., R.M., S.K., B.C., S.W.T., T.D.H.)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","unstructured":"American Heart Association. 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