ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction

Antman, Elliott M.; Anbe, Daniel T.; Armstrong, Paul W.; Bates, Eric R.; Green, Lee A.; Hand, Mary M.; Hochman, Judith S.; Krumholz, Harlan M.; Kushner, Frederick G.; Lamas, Gervasio A.; Mullany, Charles J.; Ornato, Joseph P.; Pearle, David L.; Sloan, Michael A.; Smith, Sidney C.; Alpert, Joseph S.; Anderson, Jeffrey L.; Faxon, David P.; Fuster, Valentín; Gibbons, Raymond J.; Gregoratos, Gabriel; Halperin, Jonathan L.; Hiratzka, Loren F.; Hunt, Sharon A.; Jacobs, Alice K.

doi:10.1016/j.jacc.2004.07.014

Cited by 1,006 publications

(322 citation statements)

References 715 publications

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“…In cases of STEMI, reinfarction beyond 24 hours was considered as an event and was defined according to ACC/AHA guideline criteria as. 6 i. Either re-elevation of the CPK-MB levels above the upper limit of normal and increased by at least 50% of the previous value or ii.…”

Section: Endpointmentioning

confidence: 99%

Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes

Prabhudesai

Srilakshmi

Santosh

et al. 2012

Indian Heart Journal

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Aim:To validate the global registry of acute coronary events (GRACE) score in acute coronary syndromes (ACS) patients and study its angiographic correlation. Methods and results:Two-hundred and thirty-five ACS patients were studied for the combined endpoint of all-cause in-hospital mortality and non-fatal infarction/reinfarction. We tested the predictive accuracy of the composite GRACE score using the receiver operating characteristics (ROC) curve.Lower systolic blood pressure (SBP) (odds ratio [OR] 7.93, P = 0.005), ST-segment deviation (OR 7.79, P = 0.02) and cardiac biomarker positivity (OR > 6.52, P = 0.01) were significantly associated with events. Serum creatinine > 1.4 mg/dL showed a trend towards statistical significance (OR 4.14, P = 0.05), whereas age > 50 years (OR 3.62, P = not significant [NS]) and Killips class 4 (OR 2.71, P = NS) showed good association. The best value for predicting events was a GRACE score of ≥ 217 and these patients were more likely to have double/triple vessel disease (P = 0.0009). The C statistic for the GRACE score was 0.75. Conclusion:Higher GRACE score predicts in-hospital events and more severe angiographic coronary artery disease (CAD).

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Section: Endpointmentioning

confidence: 99%

Validation of the GRACE score for prognosis in Indian patients with acute coronary syndromes

Prabhudesai

Srilakshmi

Santosh

et al. 2012

Indian Heart Journal

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“…1990), whereas the rationale for interventions specified in the first STEMI guideline was prevention of mortality and clinical and functional benefit from preserved left ventricular function (Antman et al. 2004). Recommendations for regionalization of STEMI care have been justified by expansion of access to reperfusion.…”

Section: Resultsmentioning

confidence: 99%

“…Since the first STEMI guideline (Antman et al. 2004), procedural volume has been proposed as proxy for evidence of competence (Levine et al. 2012; Kontos et al.…”

Section: Discussionmentioning

confidence: 99%

“…In 2004, the first guideline specifically addressing STEMI referred to primary percutaneous coronary intervention (PPCI) indicating that techniques such as stent implantation could result in superior outcomes compared to simple balloon angioplasty and recommended PPCI as the preferred reperfusion strategy (Antman et al. 2004). This guideline recommended development of EMS destination protocols to PPCI‐capable centers and specified procedural volume criteria as a proxy for competence.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of regionalized systems for stroke and myocardial infarction

et al. 2015

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BackgroundAcute ischemic stroke (AIS) and ST‐segment elevation myocardial infarction (STEMI) are ischemic emergencies. Guidelines recommend care delivery within formally regionalized systems of care at designated centers, with bypass of nearby centers of lesser or no designation. We review the evidence of the effectiveness of regionalized systems in AIS and STEMI.MethodsLiterature was searched using terms corresponding to designation of AIS and STEMI systems and from 2010 to the present. Inclusion criteria included report of an outcome on any dependent variable mentioned in the rationale for regionalization in the guidelines and an independent variable comparing care to a non‐ or pre‐regionalized system. Designation was defined in the AIS case as certification by the Joint Commission as either a primary (PSC) or comprehensive (CSC) stroke center. In the STEMI case, the search was conducted linking “regionalization” and “myocardial infarction” or citation as a model system by any American Heart Association statement.ResultsFor AIS, 17 publications met these criteria and were selected for review. In the STEMI case, four publications met these criteria; the search was therefore expanded by relaxing the criteria to include any historical or anecdotal comparison to a pre‐ or nonregionalized state. The final yield was nine papers from six systems.ConclusionAlthough regionalized care results in enhanced process and reduced unadjusted rates of disparity in access and adverse outcomes, these differences tend to become nonsignificant when adjusted for delayed presentation and hospital arrival by means other than emergency medical services. The benefits of regionalized care occur along with a temporal trend of improvement due to uptake of quality initiatives and guideline recommendations by all systems regardless of designation. Further research is justified with a randomized registry or cluster randomized design to support or refute recommendations that regionalization should be the standard of care.

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“…Similarly, approximately 800 people, from different age ranges, who have not been shot and shown on TV, die every day in our country 1 . The most profitable discussions that can be absorbed from those events are not related to finding the guilty ones, as if there are any single guilty parties in any of those cases, we would have to judge the other 799 daily cases, which would be humanly unfeasible and without any results, as the main emphasis would be in the lives that could have been saved.…”

mentioning

confidence: 99%