European Society of Cardiology and American College of Cardiology STEMI Guidelines

Oliveros, Estefanía; Mehta, Sameer; Ferré, Alexandra; Zhang, Tracy; Schweitzer, Michael; Arango, Miguel Vega; Arango, Juanita Gonzalez; Urrea, Maria Botero; Reina, Maria Teresa Bedoya; Yepes, Isaac

doi:10.1002/9781119095446.ch2

Manual of STEMI Interventions 2017

DOI: 10.1002/9781119095446.ch2

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European Society of Cardiology and American College of Cardiology STEMI Guidelines

Estefanía Oliveros¹,

Sameer Mehta²,

Alexandra Ferré³

et al.

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2022

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Cited by 1 publication

(4 citation statements)

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“…ST‐segment elevation myocardial infarction (STEMI) is a high mortality and morbidity condition where mortality rises with each passing minute. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 As a result, the mantra “time is myocardium” has driven initiatives to improve the timely coordination of care from screening, through diagnosis to treatment, for over 3 decades. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Screening guidelines recommend referral to an emergency department (ED) and subsequently completing and interpreting an electrocardiogram (ECG) within 10 minutes of arrival.…”

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confidence: 99%

“… 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 As a result, the mantra “time is myocardium” has driven initiatives to improve the timely coordination of care from screening, through diagnosis to treatment, for over 3 decades. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Screening guidelines recommend referral to an emergency department (ED) and subsequently completing and interpreting an electrocardiogram (ECG) within 10 minutes of arrival. 2 , 3 , 4 , 5 , 6 , 7 , 10 Information on patient risk factors associated with delays in STEMI care happen to be routinely collected upon ED arrival to initiate ED care.…”

mentioning

confidence: 99%

“…2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 Screening guidelines recommend referral to an emergency department (ED) and subsequently completing and interpreting an electrocardiogram (ECG) within 10 minutes of arrival. 2 , 3 , 4 , 5 , 6 , 7 , 10 Information on patient risk factors associated with delays in STEMI care happen to be routinely collected upon ED arrival to initiate ED care. 10 , 11 , 12 Initiating ED care consists of 2 processes: intake and triage.…”

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confidence: 99%

“…16 , 17 , 18 , 19 There is prior research identifying risk factors for STEMI as a disease. 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 However, developing a predictive model to enhance timely diagnosis requires an understanding of risk factors for STEMI diagnostic delay. 20…”

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confidence: 99%

See 3 more Smart Citations

Fallacy of Median Door‐to‐ECG Time: Hidden Opportunities for STEMI Screening Improvement

Yiadom

Gong

Patterson

et al. 2022

JAHA

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Background ST‐segment elevation myocardial infarction (STEMI) guidelines recommend screening arriving emergency department (ED) patients for an early ECG in those with symptoms concerning for myocardial ischemia. Process measures target median door‐to‐ECG (D2E) time of 10 minutes. Methods and Results This 3‐year descriptive retrospective cohort study, including 676 ED‐diagnosed patients with STEMI from 10 geographically diverse facilities across the United States, examines an alternative approach to quantifying performance: proportion of patients meeting the goal of D2E≤10 minutes. We also identified characteristics associated with D2E>10 minutes and estimated the proportion of patients with screening ECG occurring during intake, triage, and main ED care periods. We found overall median D2E was 7 minutes (IQR:4–16; range: 0–1407 minutes; range of ED medians: 5–11 minutes). Proportion of patients with D2E>10 minutes was 37.9% (ED range: 21.5%–57.1%). Patients with D2E>10 minutes, compared to those with D2E≤10 minutes, were more likely female (32.8% versus 22.6%, P =0.005), Black (23.4% versus 12.4%, P =0.005), non‐English speaking (24.6% versus 19.5%, P =0.032), diabetic (40.2% versus 30.2%, P =0.010), and less frequently reported chest pain (63.3% versus 87.4%, P <0.001). ECGs were performed during ED intake in 62.1% of visits, ED triage in 25.3%, and main ED care in 12.6%. Conclusions Examining D2E>10 minutes can identify opportunities to improve care for more ED patients with STEMI. Our findings suggest sex, race, language, and diabetes are associated with STEMI diagnostic delays. Moving the acquisition of ECGs completed during triage to intake could achieve the D2E≤10 minutes goal for 87.4% of ED patients with STEMI. Sophisticated screening, accounting for differential risk and diversity in STEMI presentations, may further improve timely detection.

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confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Fallacy of Median Door‐to‐ECG Time: Hidden Opportunities for STEMI Screening Improvement

Yiadom

Gong

Patterson

et al. 2022

JAHA

View full text Add to dashboard Cite

show abstract

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European Society of Cardiology and American College of Cardiology STEMI Guidelines

Cited by 1 publication

References 81 publications

Fallacy of Median Door‐to‐ECG Time: Hidden Opportunities for STEMI Screening Improvement

Fallacy of Median Door‐to‐ECG Time: Hidden Opportunities for STEMI Screening Improvement

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