To provide clinicians with a set of recommendations that can easily be translated into the practice of caring for patients with STEMI, this guideline is organized around the chronology of the interface between the patient and the clinician. we estimate 500 000 STEMI events per year in the U. This writing committee strongly endorses several public health campaigns that are likely to contribute to a reduction in the incidence of and fatality from STEMI in the future and additional research of new strategies for the management of STEMI patients in the community.Morbidity and mortality due to STEMI can be reduced significantly if patients and bystanders recognize symptoms early, activate the EMS system, and thereby shorten the time to definitive treatment.These goals should not be understood as ideal times but rather as the longest times that should be considered acceptable for a given system. 2003;133–7.25: Reperfusion in patients with STEMI can be accomplished by the pharmacological (fibrinolysis) or catheter-based (primary PCI) approaches.
On the basis of observations in the SHOCK Trial Registry and other registries, it is reasonable to extend such considerations of transfer to invasive centers for elderly patients with shock (see VII.F.5 and Section 7.6.5 of the full-text guidelines).Active involvement of local healthcare providers, particularly cardiologists and emergency physicians, is needed to formulate local EMS destination protocols for these patients.In general, patients with suspected STEMI should be taken to the nearest appropriate hospital.Transport time to the hospital is variable from case to case, but the goal is to keep total ischemic time within 120 minutes.
There are 3 possibilities: (1) If EMS has fibrinolytic capability and the patient qualifies for therapy, prehospital fibrinolysis should be started within 30 minutes of EMS arrival on scene.: It is also appropriate to consider emergency interhospital transfer of the patient to a PCI-capable hospital for mechanical revascularization if (1) there is a contraindication to fibrinolysis; (2) PCI can be initiated promptly (within 90 minutes after the patient presented to the initial receiving hospital or within 60 minutes compared to when fibrinolysis with a fibrin-specific agent could be initiated at the initial receiving hospital); or (3) fibrinolysis is administered and is unsuccessful (ie, “rescue PCI”).Secondary nonemergency interhospital transfer can be considered for recurrent ischemia. If the patient arrives at a non–PCI-capable hospital, the door-to-needle time should be within 30 minutes.Early access to EMS is promoted by a 9-1-1 system currently available to more than 90% of the US population.To minimize time to treatment, particularly for cardiopulmonary arrest, many communities allow volunteer and/or paid firefighters and other first-aid providers to function as first responders, providing CPR and, increasingly, early defibrillation using automated external defibrillators (AEDs) until emergency medical technicians and paramedics arrive.For patients who have ECG evidence of STEMI, it is reasonable that paramedics review a reperfusion checklist and relay the ECG and checklist findings to a predetermined medical control facility and/or receiving hospital.