American Heart Association, American College of Cardiology Foundation Publish New STEMI Guidelines

December 17, 2012—The American Heart Association and American College of Cardiology Foundation (AHA/ACCF) have published new, streamlined guidelines for the treatment of ST-elevation myocardial infarction (STEMI). The guidelines are published online in the American Heart Association's journal, Circulation, as well as the Journal of the American College of Cardiology. The guidelines were developed in collaboration with the American College of Emergency Physicians and the Society for Cardiovascular Angiography and Interventions. Patrick O'Gara, MD, is Chair of the Guidelines Writing Committee.

The AHA/ACCF guidelines focus on clinical decision making at all stages, including the onset of symptoms at home or work, regional systems of care to ensure that patients get immediate treatment, and the rapid restoration of flow down the obstructed coronary artery.

“Time is of the essence in the evaluation and treatment of these patients,” commented Dr. O'Gara in the AHA/ACCF press release. “The sooner blood flow is restored, the better the chances for survival with intact heart function.”

Dr. O'Gara added, “We are looking to a future where more patients survive with less heart damage and function well for years thereafter. We hope the guidelines will clarify best practices for healthcare providers across the continuum of care of STEMI patients.”

According to the AHA/ACCF announcement, percutaneous coronary intervention is the preferred treatment strategy when it can be done quickly. When there are delays, however, as may occur when a patient arrives at a facility where intervention is not available, clot-busting drugs should be administered if safe for the individual patient, followed by transfer to a facility where intervention can subsequently be performed if needed.

Other key points in the new guidelines include improving patient recognition of heart attack symptoms and the importance of immediately calling 911; recommending that emergency medical technicians perform electrocardiograms in the field to facilitate more rapid triage and speedier treatment; using hypothermia to treat patients experiencing cardiac arrest—to reduce brain injury in these patients, cooling protocols should be activated before or at the same time of cardiac catheterization; and providing care plans when the patient is discharged that are clearly communicated and shared with patients, families, and other health care providers. Referral for cardiac rehabilitation is a key factor. A table in the guidelines itemizes these considerations, including smoking cessation, cholesterol management, social needs, depression, and cultural and gender-related factors that may contribute to outcomes.