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)
