New guidelines published online today in Circulation and the Journal of the American College of Cardiology provide an efficient overview of the best treatments for STEMI patients. (Click here to download the PDFs of the full version (64 pages) or the executive summary (27 pages) of the 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction.)
“We’re looking to a future where more patients survive with less heart damage and function well for years thereafter,” said Patrick O’Gara, the chair of the guidelines writing committee, in a press release. “We hope the guidelines will clarify best practices for healthcare providers across the continuum of care of STEMI patients.”
The new document strongly supports the establishment and maintenance of regional systems to treat STEMI, which should include assessment and continuous quality improvement programs.
Primary PCI remains the preferred method of reperfusion when it can be performed by experienced operators in a timely fashion. For people who can’t receive primary PCI within 120 minutes of arrival, fibrinolytic therapy should be given within 12 hours of the the onset of symptoms.
The first medical contact (FMC)-to-device time should be 90 minutes at PCI-capable hospitals. Patients who arrive at non PCI-capable hospitals should be transported to a PCI-capable hospital within 30 minutes and should be treated with a FMC-to-device system goal of 120 minutes of less.
Drug-eluting stents should not be used in patients who can’t or won’t comply with long-term dual antiplatelet therapy (DAPT). After receiving a stent patients should receive DAPT with aspirin and either clopidogrel, prasugrel, or ticagrelor.
New guidelines can improve treatment for severe heart attack patients
- New streamlined guidelines will help healthcare providers better treat patients with the most severe form of heart attack known as STEMI.
- Coronary intervention with balloon angioplasty and stents is the preferred treatment when it can be performed in a timely fashion.
- Patient delay in reporting symptoms is one of the most important obstacles to timely and successful care.
DALLAS, Dec. 17, 2012 — New streamlined guidelines will help healthcare providers better treat patients with the most severe type of heart attack
s, according to an American Heart Association/American College of Cardiology statement.
The guidelines are published online in the American Heart Association journal Circulationand the Journal of the American College of Cardiology.
The new recommendations are for a type of heart attack known as ST-elevation myocardial infarction (STEMI
), which occurs when a cholesterol plaque
ruptures and a blood clot forms within an artery leading to the heart muscle, completely obstructing the flow of blood. A potentially large area of the heart may be affected by the resultant injury.
“Time is of the essence in the evaluation and treatment of these patients,” said Patrick O’Gara, chair of the guidelines writing committee. “The sooner blood flow is restored, the better the chances for survival with intact heart function.”
The most feared STEMI complications are the emergence of a lethal arrhythmia – a heart rhythm abnormality which can lead to cardiac arrest — and heart failure as a result of the loss of a large amount of heart muscle. About 250,000 Americans suffer an ST-elevation MI each year.
The guidelines focus on clinical decision-making at all stages, beginning with the onset ofsymptoms
at home or work, regional systems of care
to ensure that patients get immediate treatment, and the rapid restoration of flow down the obstructed coronary artery.
Percutaneous coronary intervention (PCI), which comprises balloon angioplasty to open a clogged artery and stents to keep it open, is the preferred treatment strategy when it can be done quickly. When there are delays, as may occur when a patient arrives at a facility where intervention is not available, clot-busting drugs should be administered if safe for the individual patient, followed by transfer to a facility where intervention can subsequently be performed if needed.
Other key points in the new guidelines include:
- Improving patient recognition of heart attack symptoms and the importance of immediately calling 911. Patient delay in reporting symptoms is one of the greatest obstacles to timely and successful care. Travel by private car to the hospital is strongly discouraged.
- Recommending that emergency medical technicians perform electrocardiograms in the field to facilitate more rapid triage and speedier treatment.
- Using hypothermia (cooling) to treat patients who suffer cardiac arrest . To reduce brain injury in these patients, cooling protocols should be activated before or at the same time of cardiac catheterization.
- Providing care plans when the patient is discharged after STEMI, which are clearly communicated and shared with patients, families, and other healthcare providers. Referral for cardiac rehabilitation is a key factor. A table in the guidelines itemizes these considerations, including smoking cessation, cholesterol management, social needs, depression, and cultural and gender-related factors that may contribute to outcomes.
“We’re looking to a future where more patients survive with less heart damage and function well for years thereafter,” said O’Gara, who is also the executive medical director of the Shapiro Cardiovascular Center and director of clinical cardiology at Brigham and Women’s Hospital in Boston, Mass. “We hope the guidelines will clarify best practices for healthcare providers across the continuum of care of STEMI patients.”
The guidelines were developed in collaboration with the American College of Emergency Physicians and the Society for Cardiovascular Angiography and Interventions.
Co-authors are: Frederick G. Kushner, M.D.; Deborah D. Ascheim, M.D.; Donald E. Casey Jr., M.D., M.P.H., M.B.A.; Mina K. Chung, M.D.; James A. de Lemos, M.D.; Steven M. Ettinger, M.D.; James C. Fang, M.D.; Francis M. Fesmire, M.D.; Barry A. Franklin, Ph.D.; Christopher B. Granger, M.D.; Harlan M. Krumholz, M.D., S.M.; Jane A. Linderbaum, M.S., C.N.P.; David A. Morrow, M.D., M.P.H.; L. Kristin Newby, M.D., M.H.S.; Joseph P. Ornato, M.D.; Narith Ou, Pharm.D.; Martha J. Radford, M.D.; Jacqueline E. Tamis-Holland, M.D.; Carl L. Tommaso, M.D.; Cynthia M. Tracy, M.D.; Y. Joseph Woo, M.D.; and David X. Zhao, M.D. Author disclosures are on the manuscript.
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