New ST Elevation Myocardial Infarction (STEMI) Guidelines

 

The new ST-Elevation Myocardial Infarction (STEMI) guidelines were released on Monday, December 17th, 2012.

 

The "2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines" speaks to the importance of system wide effort and references Mission: Lifeline® recommendations for a multidimensional approach to STEMI care.

 

Launched in 2007, Mission: Lifeline is the American Heart Association's quality improvement program designed to encourage and improve the systematic approach to STEMI and Out-of-Hospital Cardiac Resuscitation treatment. As stated in the 2013 AHA/ACC STEMI guidelines, "Mission: Lifeline recommends a multifaceted community-wide approach that involves:

  • Patient education
  • Improvements in EMS and ED care
  • Establishment of networks of STEMI-referral (non-PCI-capable) and STEMI-receiving (PCI-capable) hospitals
  • Coordinated advocacy efforts to work with payers and policy makers to implement healthcare system redesign"

The new 2013 STEMI guidelines comes nearly 9 years after the 2004 ACC/AHA guideline release and contains the latest recommendations for STEMI care, including regional system care and time-to-treatment recommendations. 

 

The eight 2013 system goals are as follows:

  1. "All communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of EMS and hospital-based activities. Performance can be facilitated by participating in programs such as Mission: Lifeline and the D2B Alliance."  
  2. "Performance of a 12-lead ECG by EMS personnel at the site of first medical contact (FMC) is recommended in patients with symptoms consistent with STEMI."  
  3. "Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours."  
  4. "Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators."  
  5. "EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI, with an ideal FMC-to-device time system goal of 90 minutes or less."  
  6. "Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non-PCI-capable hospital, with a FMC to-device time system goal of 120 minutes or less."  
  7. "In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non-PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays."  
  8. "When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be administered within 30 minutes of hospital arrival."

Developed in Collaboration with the American College of Emergency Physicians and Society for Cardiovascular Angiography and Interventions, these updated guidelines are now available online in the American Heart Association journal Circulation and the Journal of the American College of Cardiology, or in the News and Top Topics section of the Mission: Lifeline website.

 

For more information on Mission: Lifeline, registering a system of care, or achieving recognition or accreditation with Mission: Lifeline through QI feedback reports, please visit our Mission: Lifeline homepage http://www.heart.org/missionlifeline