2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary

O’Gara, Patrick T.; Kushner, Frederick G.; Ascheim, Deborah D.; Casey, Donald E.; Chung, Mina K.; Lemos, James A. de; Ettinger, Steven M.; Fang, James C.; Fesmire, Francis M.; Franklin, Barry A.; Granger, Christopher B.; Krumholz, Harlan M.; Linderbaum, Jane A.; Morrow, David A.; Newby, L. Kristin; Ornato, Joseph P.; Ou, Narith N.; Radford, Martha J.; Tamis‐Holland, Jacqueline E.; Tommaso, Carl L.; Tracy, Cynthia M.; Woo, Y. Joseph; Zhao, David

doi:10.1016/j.jacc.2012.11.018

Cited by 865 publications

(178 citation statements)

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“…Compared with the Euro Heart Survey in 20055 or the REACH Registry in 200717 and 2010,18 the rates of use of evidence‐based medications for secondary prevention appear to be higher in the CLARIFY stable‐CAD population, reflecting increasing adherence to international guidelines in routine clinical practice 19, 20, 21, 22, 23. Despite this improvement, prevalence and control of major CV risk factors vary markedly worldwide, with many outpatients with stable CAD being treated suboptimally 24…”

Section: Discussionmentioning

confidence: 99%

Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease

Sorbets

Greenlaw

Ferrari

et al. 2017

Clinical Cardiology

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BackgroundDespite major advances in prevention and treatment, coronary artery disease (CAD) remains the leading cause of death worldwide. Whereas many sources of data are available on the epidemiology of acute coronary syndromes, fewer datasets reflect the contemporary management and outcomes of stable CAD patients.HypothesisA worldwide contemporary registry would improve our knowledge about stable CAD. The main objectives are to describe the demographics, clinical profile, contemporary management and outcomes of outpatients with stable CAD; to identify gaps between evidence and treatment; and to investigate long‐term prognostic determinants.Methods CLARIFY (ProspeCtive observational LongitudinAl RegIstry oF patients with stable coronary arterY disease) is an ongoing international observational longitudinal registry. Stable CAD patients from 45 countries in Europe, Asia, America, Middle East, Australia and Africa were enrolled between November 2009 and June 2010. The inclusion criteria were previous myocardial infarction, evidence of coronary stenosis >50%, proven symptomatic myocardial ischemia or prior revascularization procedure. The main exclusion criteria were serious non‐cardiovascular disease, conditions interfering with life expectancy or severe other cardiovascular disease (including advanced heart failure). Follow‐up visits were planned annually for up to 5 years, interspersed with 6‐month telephone calls.ResultsOf the 32,703 patients enrolled, most (77.6%) were male, age (mean ± SD) was 64.2 ± 10.5 years, and 71.0% were receiving treatment for hypertension; mean ± SD resting heart rate was 68.2 ± 10.6 bpm. Patients were enrolled based on a history of myocardial infarction >3 months earlier (57.7%), having at least one stenosis >50% on coronary angiography (61.1%), proven symptomatic myocardial ischemia on non‐invasive testing (23.1%), or history of percutaneous coronary intervention or coronary artery bypass graft (69.8%). Baseline characteristics were similar across the four subgroups identified by the four inclusion criteria.Conclusion CLARIFY will provide a useful resource for understanding the current epidemiology of stable CAD.

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Section: Discussionmentioning

confidence: 99%

Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease

Sorbets

Greenlaw

Ferrari

et al. 2017

Clinical Cardiology

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“…Despite decades of evidence, including randomized trial data calling for primary PCI within FMC2D times of ≤90 minutes for direct EMS‐transported cases and ≤120 minutes for patients requiring interhospital transfer, up to 30% to 50% of all patients with STEMI are not treated within these guideline‐recommended goals for timely reperfusion 5, 10, 11, 12, 13, 14. Previous studies have shown that patients with STEMI with OHCA constitute an important subgroup, with significantly higher rates of system delay and mortality relative to patients with STEMI without OHCA 1.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Care and Outcomes for Emergency Medical Service–Transported Patients With ST‐Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline STEMI Accelerator Study

Kragholm

Chiswell

et al. 2017

JAHA

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BackgroundPatients with ST‐elevation myocardial infarction (STEMI) with out‐of‐hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non‐PCI hospitals to go to a PCI center.Methods and ResultsWe reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI‐capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service–transported patients, 88.7% (N=11 703; 10.5% OHCA) were taken directly to PCI hospitals. Among 1486 transfer‐in patients, 21.7% had OHCA. Direct transport to a PCI center for OHCA increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02–1.14), versus 89.0% to 91.0% for patients without OHCA (odds ratio, 1.03; 95% confidence interval, 0.99–1.07; interaction P=0.23). The proportion with prehospital ECGs increased for patients taken directly to PCI centers (53.9%–61.9% for those with OHCA versus 73.9%–81.9% for those without OHCA; interaction P=0.12). Of 997 patients with OHCA taken directly to PCI hospitals and treated with primary PCI, first medical contact‐to‐device times within the guideline‐recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction P=0.72).ConclusionsDirect transport to PCI hospitals increased for patients with STEMI with and without OHCA during the 2012 to 2014 Mission: Lifeline STEMI Accelerator program. Proportions with prehospital ECGs and timely reperfusion increased for patients taken directly to PCI hospitals.

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“…Guidelines for times to treatment have been established by professional societies in both North America and Europe. 1,2 Transfer of STEMI patients for PPCI is associated with longer delays to reperfusion overall, related to both the turnaround time at the initial center and the subsequent time spent transporting the patient to the second hospital. Recent research in the United States has found that transferred STEMI patients rarely achieve the recommended benchmark 1 of a first door-in to first door-out (DIDO) time within 30 minutes.…”

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confidence: 99%

Transfer of Patients With ST-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention

et al. 2014

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Background-Interhospital transfer of patients with ST-elevation myocardial infarction (STEMI) for primary percutaneous coronary intervention (PPCI) is associated with longer delays to reperfusion, related in part to turnaround ("door in" to "door out," or DIDO) time at the initial hospital. As part of a systematic, province-wide evaluation of STEMI care, we examined DIDO times and associations with patient, hospital, and process-of-care factors. Methods and Results-We performed medical chart review for STEMI patients transferred for PPCI during a 6-month period (October 1, 2008, through March 31, 2009) and linked these data to ambulance service databases. Two core laboratory cardiologists reviewed presenting ECGs to identify left bundle-branch block and, in the absence of left bundlebranch block, definite STEMI (according to both cardiologists) or an ambiguous reading. Median DIDO time was 51 minutes (25th to 75th percentile: 35-82 minutes); 14.1% of the 988 patients had a timely DIDO interval (≤30 minutes as recommended by guidelines). The data-to-decision delay was the major contributor to DIDO time. Female sex, more comorbidities, longer symptom duration, arrival by means other than ambulance, arrival at a hospital not exclusively transferring for PPCI, arrival at a center with a low STEMI volume, and an ambiguous ECG were independently associated with longer DIDO time. When turnaround was timely, 70% of patients received timely PPCI (door-to-device time ≤90 minutes) versus 14% if turnaround was not timely (P<0.0001). Key Words: emergency medical services ◼ guideline adherence ◼ myocardial infarction ◼ quality of health care Conclusions-Benchmark

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2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: Executive Summary

Cited by 865 publications

References 214 publications

Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease

Rationale, design, and baseline characteristics of the CLARIFY registry of outpatients with stable coronary artery disease

Improvement in Care and Outcomes for Emergency Medical Service–Transported Patients With ST‐Elevation Myocardial Infarction (STEMI) With and Without Prehospital Cardiac Arrest: A Mission: Lifeline STEMI Accelerator Study

Transfer of Patients With ST-Elevation Myocardial Infarction for Primary Percutaneous Coronary Intervention

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