STEMI Treatment
Fast, Effective Response Means Lifesaving Care
Almost 400,000 Americans suffer an ST-segment elevation myocardial infarction (STEMI) annually, according to the American Heart Association (AHA). For patients with STEMIs, rapid reperfusion is vital to sparing the heart from serious damage, says David Burt, M.D., an assistant professor of medicine at the University of Virginia Health System. "Time equals muscle," he says. However, less than half of STEMI patients receive appropriate treatment within the recommended timeframes, according to the AHA.
By contrast, the UVA Health System provides STEMI patients with percutaneous coronary intervention (PCI) - the most effective treatment for a STEMI - in less than 90 minutes, the national standard for providing PCI. In the first quarter of 2007, the most recent timeframe with available data, 92 percent of STEMI patients at UVA received PCI in less than 90 minutes, with a median time of 76 minutes.
The key to UVA's fast, effective treatment for STEMI patients is an experienced, multidisciplinary team that brings together cardiologists, emergency department physicians and UVA's nationally accredited Chest Pain Center to treat patients around the clock using detailed treatment protocols.
Rapid Diagnosis Anywhere in the Region
UVA can begin the STEMI treatment process even before a patient reaches the hospital, Burt says. Many rescue squads have the ability to electronically transmit results from 12-lead electrocardiograms during patient transport. These are then analyzed by physicians at UVA's Chest Pain Center to determine if a patient is experiencing a STEMI.
Physicians calling in from other hospitals or treatment centers with a STEMI patient can always reach one of UVA's cardiology fellows, who are on call 24 hours a day. The cardiology fellow will trigger the alert system, develop a treatment plan for the patient and arrange their transfer to UVA, says cardiology fellow David Jones, M.D. A conference call is immediately commenced with everyone at UVA who will be involved in providing care for the patient.
In addition to these two protocols, any patient who arrives at UVA's emergency department and is suspected of having a STEMI is diverted to the Chest Pain Center, says Chris Ghaemmaghami, M.D., the center's director.
While a STEMI can be treated anywhere in the ED, Ghaemmaghami says the Chest Pain Center is ideally situated to give the patient a complete workup, precisely determine the cause of their chest pain and develop the best treatment plan.
A Detailed Treatment Plan, Constantly Improved
Once a STEMI patient is identified, Burt says, UVA's STEMI Alert Team is mobilized and the treatment process "converts into a military operation." The cardiac catheterization lab team is called in, the cardiology fellow on call is paged, and a STEMI alert packet developed at UVA is opened. The packet provides a checklist of detailed, step-by-step procedures to follow. UVA's cardiac catheterization lab is available 24 hours a day to perform immediate interventions.
"You don't have to remember everything - just open the packet and follow the instructions," Burt says.
"This really mobilizes everyone up front," adds Ghaemmaghami. "Everyone has a role, and everyone does it quickly and efficiently."
A scribe tracks the patient's minute-by-minute movement through the treatment process, says Barbara Craighead, R.N., keeping detailed track of timepoints to help the STEMI team pinpoint areas for improvement at monthly meetings where every case is reviewed. UVA's goal is to have all STEMI patients receive PCI in less than 60 minutes, says Michael Ragosta, M.D., the medical director of interventional cardiology at UVA.
"To do that, you have to be constantly monitoring the system, tweaking it, and we're committed to doing that," Ragosta says.
Once the PCI is done, UVA provides comprehensive follow-up care in its Coronary Care Unit, with 24/7 physician monitoring and bypass backup available at all times, Jones says. UVA also keeps the patient's primary care physician informed about the patient's treatment and any follow-up care that is required, Burt says.
Building a Regional STEMI Network
UVA has developed a regional STEMI alert process with Culpeper Regional Hospital to provide the most effective treatment for patients based on their individual condition, Burt says. UVA is working on adding more hospitals to the regional alert process, he says.
"UVA will work with those hospitals to provide the best, fastest treatment, including transport to UVA for a cardiac catheterization," Burt says.
To speak with someone on UVA's STEMI team, call UVA Physician Direct at 800-552-3723.