STEMI Heart Attack Care Improving in US Hospitals

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If you are at WakeMed Heart Center in Raleigh NC, you may hear an overhead announcement that you don’t recognize. “CODE STEMI” is activated if you present at the Emergency Department with Acute Coronary Syndrome or Acute Myocardial Infarction (heart attack). The emergency response team there will get you appropriate care – called “door to balloon” – within 90 minutes.

According to a new analysis by the American College of Cardiology’s National Cardiovascular Data Registry, hospitals across the country have improved their care of heart attack patients and are increasingly administering therapies timely, safely, and according to clinical guidelines.

Matthew T. Roe MD of Duke University Medical Center analyzed data on almost 132,000 heart attack patients treated at approximately 250 centers from January 2007 to June 2009. The researchers found improvements particularly in the treatment of ST-segment elevation myocardial infarction (STEMI) patients, including an increased use of treatments that restore blood flow to the heart. Risk-adjusted hospital deaths decreased in both STEMI and non-STEMI patients.

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STEMI is a type of severe heart attack in which the coronary artery is completely blocked off by a blood clot. A STEMI is usually recognized by an elevation of the ST segment on an ECG, which indicates that a large amount of heart muscle damage is occurring.

The data also showed that there was a significant increase in the proportion of patients treated with the kind of system WakeMed has, which aims to perform a percutaneous coronary intervention (PCI) on appropriate heart attack patients within 90 minutes of presentation. A procedure called PTCA, or balloon angioplasty, is typically performed by threading a slender balloon-tipped catheter from an artery in the groin to the blocked artery. The balloon is then inflated, compressing the plaque and dilating the narrowed artery so that blood can flow more easily.

The CODE STEMI works by bringing together a response team from the EMS staff, ED personnel, critical care nurses, respiratory therapy, and the Heart Center’s Cath Lab. The plan is put into action before you arrive at the hospital (if you have called an ambulance) with the emergency technician faxing your EKG to the hospital’s emergency department. If a heart attack or ACS is diagnosed, the CODE STEMI response team immediately prepares for primary angioplasty, thrombolytic therapy or even emergency bypass surgery.

"The contemporary profile of care patterns for patients with acute myocardial infarction and those undergoing PCI indicates that patient and procedural characteristics have changed over a relatively short time, while significant improvements in the receipt and timeliness of reperfusion therapy for STEMI, in the overdosing of antithrombotic therapies, in the safety and results of PCI procedures, and in composite measures of acute myocardial infarction care were also demonstrated," the authors write.

The Duke University study is published in the July 20 issue of the Journal of the American College of Cardiology.

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