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.
- 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.