ST-elevation myocardial infarction (STEMI) is a major cause of morbidity and mortality worldwide.
Despite improvements in care, up to one-third of patients presenting with STEMI within 12h of symptom onset still receive no reperfusion therapy acutely.
Timely reperfusion of the infarct-related coronary artery both with fibrinolysis or percutaneous coronary intervention reduces infarct size, and decreases morbidity and mortality.
Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner.
Strategies to reduce health system–related delays in reperfusion include regionalization of ST-segment–elevation myocardial infarction care and protocols, prehospital ECGs and treatment initiation, prehospital activation of the catheterisation laboratory, bypassing non percutaneous coronary intervention–capable hospitals and emergency rooms of capable hospitals, and permanent and early availability of the catheterisation laboratory team, preferably in high volume centers.
The optimal combination of a pharmacologic approach and mechanical reperfusion allows to improve further patient outcomes.
Prof. Gilles Montalescot
Head of Cardiology department
Resources below have been selected by Dr. Claudio Montalto
ACVC Essentials 4 You
A selection of sessions in the field:
- Pharmaco-invasive strategy in patients with STEMI according to a randomised clinical trial FRIDOM1 with a 1-year mortality estimate- E Gerasimets
Access a selection of relevant course in the field:
Acute Cardiovascular Care Congress resources
- ECG to PCI time delays - ESC recommendations and STEMI networks performance - By M.Gierlotka
- Relation of lowering door to balloon time and mortality in st segment elevation myocardial infarction patients undergoing percutaneous coronary intervention - By Y. Schcham
- Very late presenters of STEMI (between 48 and 72 hours): does late PCI still improve clinical outcomes? - By A. Gamal
ACVC Clinical Decision-Making Toolkit
Acute Coronary Syndrome with three algorithms dedicated to reperfusion strategies in STEMI (pages 34-36). Access the toolkit
selection of articles in the field
- Long-term effects of a standardized feedback-driven quality improvement program for timely reperfusion therapy in regional STEMI care networks
- The benefit and harm of treating STEMI: Between ischemia, bleeding, and reperfusion injury
Fourth Universal Definition of Myocardial Infarction Essentials for clinical practice. Access the poster