Inappropriate cath lab activation due to pseudoSTEMI

Inappropriate treatment of patients presenting with chest pain is an increasingly recognized consequence of the performance driven STEMI versus non-STEMI designation. The most widely discussed examples of this take the form of missed coronary occlusion due to over reliance on simple ST segment criteria. Another aspect of the problem was illustrated in this recent paper: inappropriate cath lab activation due to STMI mimics. From the article:

There were a total of 139 activations with 77 having a STEMI diagnosis confirmed and 62 activations where there was no STEMI. The inappropriate activations resulted from a combination of atypical symptoms and misinterpretation of the ECG (45% due to anterior ST-segment elevation) on patient presentation.

The fact that almost half the cath lab activations were inappropriate is concerning enough. Worse, though, was the fact that this occurred at an academic medical center.