Systems of Care for ST-Segment–Elevation Myocardial Infarction: A Policy Statement From the American Heart Association

Abstract

The introduction of Mission: Lifeline significantly increased timely access to percutaneous coronary intervention for patients with ST-segment–elevation myocardial infarction (STEMI). In the years since, morbidity and mortality rates have declined, and research has led to significant developments that have broadened our concept of the STEMI system of care. However, significant barriers and opportunities remain. From community education to 9-1-1 activation and emergency medical services triage and from emergency department and interfacility transfer protocols to postacute care, each critical juncture presents unique challenges for the optimal care of patients with STEMI. This policy statement sets forth recommendations for how the ideal STEMI system of care should be designed and implemented to ensure that patients with STEMI receive the best evidence-based care at each stage in their illness.

Culprit vessel revascularization first with primary use of a dedicated transradial guiding catheter to reduce door to balloon time in primary percutaneous coronary intervention

“…A shorter D2B time for individual patients is associated with lower mortality in hospitals ( 2 , 15 , 16 ), at 30 days ( 2 , 16 ), at 6 months ( 17 ), or 1 year ( 2 , 3 ). There has been extensive research on strategies to improve D2B time, including shortening the door to ECG and ECG to activation time ( 18 ), prehospital activation and direct to the cath lab ( 19 , 20 ), and data feedback with each member in the system of care ( 20 ). However, little attention has been paid to the effect of the sequence of the catheter on D2B time in transradial access.…”

Utility of prehospital electrocardiogram interpretation in ST‐segment elevation myocardial infarction utilizing computer interpretation and transmission for interventional cardiologist consultation

“…In healthcare settings where paramedics trained in ECG interpretation are not available, utilizing computer algorithms to detect STEMI in the field may be an attractive strategy to reduce total ischemic time. [3][4][5][6] However, in the absence of clinician over-read, this strategy has been associated with high rates of false-negative/positive STEMI diagnoses and inappropriate cardiac catheter laboratory (CCL) activations. [7][8][9][10][11][12][13][14] As a result, some guidelines recommend clinician oversight of computer-based CCL activation strategies.…”

“…The PH‐ECG can be interpreted by computer algorithms, paramedics, or transmission to clinicians for over‐read. In healthcare settings where paramedics trained in ECG interpretation are not available, utilizing computer algorithms to detect STEMI in the field may be an attractive strategy to reduce total ischemic time 3–6 . However, in the absence of clinician over‐read, this strategy has been associated with high rates of false‐negative/positive STEMI diagnoses and inappropriate cardiac catheter laboratory (CCL) activations 7–14 .…”

D-dimer to Creatinine Ratio: A Novel Biomarker Associated with Gensini Score in ST-Segment Elevation Myocardial Infarction Patients

“…Acute ST-segment elevation myocardial infarction (STEMI) is one of the critical conditions endangering human health worldwide, with rapid onset and high mortality. 1 The most common cause is complete occlusion of the epicardial coronary artery by intracoronary thrombosis. Reperfusion therapy, including thrombolytic therapy, percutaneous coronary intervention (PCI), or coronary artery bypass surgery must be performed as early as possible.…”