New guidelines can improve treatment for severe heart attack patients

December 17, 2012

New streamlined guidelines will help healthcare providers better treat patients with the most severe type of heart attacks, according to an American Heart Association/American College of Cardiology statement.

The guidelines are published online in the American Heart Association journal Circulation and the Journal of the American College of Cardiology. The new recommendations are for a type of heart attack known as ST-elevation myocardial infarction (STEMI), which occurs when a cholesterol plaque ruptures and a blood clot forms within an artery leading to the heart muscle, completely obstructing the flow of blood. A potentially large area of the heart may be affected by the resultant injury.

"Time is of the essence in the evaluation and treatment of these patients," said Patrick O'Gara, chair of the guidelines writing committee. "The sooner blood flow is restored, the better the chances for survival with intact heart function."

The most feared STEMI complications are the emergence of a lethal arrhythmia - a heart rhythm abnormality which can lead to cardiac arrest -- and heart failure as a result of the loss of a large amount of heart muscle. About 250,000 Americans suffer an ST-elevation MI each year. The guidelines focus on clinical decision-making at all stages, beginning with 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.

Percutaneous coronary intervention (PCI), which comprises balloon angioplasty to open a clogged artery and stents to keep it open, is the preferred treatment strategy when it can be done quickly. When there are delays, 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:"We're looking to a future where more patients survive with less heart damage and function well for years thereafter," said O'Gara, who is also the executive medical director of the Shapiro Cardiovascular Center and director of clinical cardiology at Brigham and Women's Hospital in Boston, Mass. "We hope the guidelines will clarify best practices for healthcare providers across the continuum of care of STEMI patients."
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The guidelines were developed in collaboration with the American College of Emergency Physicians and the Society for Cardiovascular Angiography and Interventions.

More information on quick treatment for STEMI is on our Mission Lifeline website, where you can also find a map to locate STEMI systems of care.

Co-authors are: Frederick G. Kushner, M.D.; Deborah D. Ascheim, M.D.; Donald E. Casey Jr., M.D., M.P.H., M.B.A.; Mina K. Chung, M.D.; James A. de Lemos, M.D.; Steven M. Ettinger, M.D.; James C. Fang, M.D.; Francis M. Fesmire, M.D.; Barry A. Franklin, Ph.D.; Christopher B. Granger, M.D.; Harlan M. Krumholz, M.D., S.M.; Jane A. Linderbaum, M.S., C.N.P.; David A. Morrow, M.D., M.P.H.; L. Kristin Newby, M.D., M.H.S.; Joseph P. Ornato, M.D.; Narith Ou, Pharm.D.; Martha J. Radford, M.D.; Jacqueline E. Tamis-Holland, M.D.; Carl L. Tommaso, M.D.; Cynthia M. Tracy, M.D.; Y. Joseph Woo, M.D.; and David X. Zhao, M.D. Author disclosures are on the manuscript.

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The American Heart Association/American Stroke Association receives funding mostly from individuals. Foundations and corporations donate as well, and fund specific programs and events. Strict policies are enforced to prevent these relationships from influencing the association's science content. Financial information for the American Heart Association, including a list of contributions from pharmaceutical companies and device manufacturers, is available at www.heart.org/corporatefunding.

American Heart Association

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