Document Detail

Bypassing the Emergency Department to Improve the Process of Care for ST-Elevation Myocardial Infarction: Necessary but Not Sufficient.
MedLine Citation:
PMID:  23788526     Owner:  NLM     Status:  Publisher    
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.)
Elliott M Antman
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-6-20
Journal Detail:
Title:  Circulation     Volume:  -     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2013 Jun 
Date Detail:
Created Date:  2013-6-21     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
1Brigham & Women's Hospital, Boston, MA, 02115.
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