Bypassing the Emergency Department to Improve the Process of Care for ST-Elevation Myocardial Infarction: Necessary but Not Sufficient
The last several decades have been marked by dramatic advances in the management of patients with an acute decompensation of ischemic heart disease. A now common phrase in our clinical lexicon is acute coronary syndrome (ACS), which is further subdivided into presentations with and without ST-segment elevation on the ECG - thus dividing ACS presentations into ST-segment elevation MI (STEMI) and unstable angina/non-ST-segment MI (UA/NSTEMI). 1 Given the time urgency of restoring antegrade flow in the culprit coronary artery in STEMI, it is understandable that a major focus of clinical research has been defining the optimal reperfusion regimen - first with fibrinolysis and later catheter-based interventions.
In 2006, an AHA Consensus Statement was published outlining the fact that, at the time, only a minority of patients with STEMI in the United States received primary percutaneous coronary intervention (PCI) and, in those who did, fewer than 40% were treated within 90 minutes after hospital arrival. 2 The AHA convened an acute MI Advisory Working Group that agreed the next step in the process after the initial consensus statement was to develop an implementation plan to establish a system of care to increase the number of patients with STEMI who received timely access to primary PCI. Within a year, a conference was held with representation from all the key stakeholders, the success of early model STEMI systems was reviewed, and the AHA launched Mission:Lifeline, an initiative to improve the quality of care and outcomes for patients with STEMI and to improve the healthcare system readiness and response to STEMI. 3
- systems of care
- ST-segment elevation myocardial infarction
- myocardial infarction
- acute coronary syndrome
- systems of care
- Received June 14, 2013.
- Accepted June 17, 2013.