ACC GUIDELINES Bundle

ST-Elevation Myocardial Infarction (STEMI) (ACCF Bundle)

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Key Points ÎÎSystems of care should be established in each community to care for patients with ST-Elevation Myocardial Infarction (STEMI) with the ultimate goal of reducing total ischemic time between symptom onset and reperfusion. ÎÎPrimary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with STEMI when it can be done in a timely fashion (ie, within 2 hours of first medical contact) by expert operators. ÎÎFollowing delivery of fibrinolytic therapy when indicated, patients should be transferred to a PCI-capable center, even if clinically stable with signs of successful reperfusion. ÎNon-infarct artery PCI, when indicated, should be deferred to a time Î remote from primary PCI in the absence of shock or severe heart failure. Treatment Onset of Myocardial Infarction (MI) Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to-Treatment Goals ÎÎAll communities should create and maintain a regional system of STEMI care that includes assessment and continuous quality improvement of emergency medical services (EMS) and hospitalbased activities. Performance can be facilitated by participating in programs such as Mission: Lifeline (www.heart.org/missionlifeline) and the D2B Alliance (www.d2balliance.org/). (I-B) ÎÎPerformance of a 12-lead electrocardiogram (ECG) by EMS personnel at the site of first medical contact (FMC) is recommended in patients with symptoms consistent with STEMI. (I-B) ÎÎReperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours. (I-A)

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