Cath Lab Digest - February 2008 - (Page 34)

34 STEMI INTERVENTIONS FEBRUARY 2008 Treatment now includes supplemental oxygen, Table 5. telemetry, anti-platelets and National Trauma System & Acute Myocardial Infarction — More Similarities than Differences anti-coagulants, and intraBenchmarks National Trauma System Acute MI venous nitroglycerine is administered. Later in the Annual Mortality 161,269 459,840 night, the patient requires morphine for relief of recurPublic Health Epidemic Trauma is leading cause of death 14 million Americans have a history of rent chest pain. A follow-up for Americans aged 35 and heart attack or angina; 50% die within ECG in the morning demonyounger; children account for 25% first hour before reaching the hospital; strates persistent ST-segment of all traumatic injuries; 33 million 42% women die within 1 year after a elevation and the cardiologist ED visits for injuries every year heart attack arranges for a transfer to the nearest hospital for a coroLack of Uniform Access 45 million Americans are unable to 50% heart attack victims wait for more nary angiogram. Transfer access high-level trauma trauma than 2 hours before seeking help occurs in the afternoon care within the traditional golden uneventfully, and soon after hour after injury arrival, a coronary angiogram reveals an ulcerated 90% Massive Cost to Taxpayers Annual direct cost of injury $117 Costs related to STEMI cost $60 bilproximal left anterior descendbillion lion/year ing artery (LAD) lesion and TIMI-2 flow, the anterior wall Specialized, Integrated Centers 1,154 trauma centers in the U.S. – Approximately 1,200 PCI-capable carand apex are severely hypo190 Level 1, 263 Level 2 diac catheterization laboratories; no kinetic, and left ventricular specialized acute MI or STEMI center ejection fraction (LVEF) is 35%. A successful percuta1. Cales RH, Trunkey DD. Preventable trauma deaths. A review of trauma care systems development. JAMA 1985;254:1059–1063. 2. Pollock DA, McClain PW. Trauma registries. Current status and future prospects JAMA 1989;262:2280–2283. neous coronary intervention (PCI) is performed and a This is an example of suboptimal universally, in an efficient, scientific, 2. Logistics notwithstanding, is a drug-eluting stent is placed, restoring default PCI strategy not the best flow in the LAD. Discharge from the American medicine. Compared to standardized and cost-effective manway to treat STEMI globally? hospital occurs on the fourth day. the former example, the poor care in ner. Looking beyond the cardiovascu3. What should be the mechaThe patient is discharged on multiple the latter example is a result of the lar laboratory and assessing the ongonisms of delivering the medications. One month after his acute disparate treatment of acute MI ing dramatic changes in the manageappropriate strategy and in myocardial infarction (MI), the patient compared to trauma and from the ment of STEMI occurring within the incorporating the EMS — continues to have significant dyspnea lack of a National Heart Attack general community requires us to briefly review the present status of specifically, do we need a with exertion, is unable to return to Response System. …We are likely on the verge of STEMI triage and treatment. There national STEMI policy? work and is considering disability. A follow-up echocardiogram demon- witnessing a massive restructuring are three specific issues which must strated no significant improvement in of healthcare resources and priori- be addressed: Barriers to an Integrated STEMI 1. Achieve a consensus about the left ventricular systolic function with ties, nationally and globally, as we System and National STEMI Policy strive to provide STEMI interventions role of the three major global severe apical hypokinesis. Figure 1 summarizes the three STEMI strategies: Pre-hospital groups of barriers that appear prethrombolysis, pharmacodominantly responsible in preventing invasive strategies and pure formations of more successful inteinvasive strategies (Table 1). grated STEMI systems. It is felt that all 1. Goff DC, Mitchell P, Finnegan J, et al; for the REACT Study Group. Knowledge of heart attack symptoms in 20 US communities. Results from the rapid early action for coronary treatment community trial. Preventive Medicine Jan 2004;38(1):85-93(9). 2. Pattenden J, Watt I, Lewin JPR, Stanford N. Decision making processes in people with symptoms of acute myocardial infarction: qualitative study. BMJ 2002;324:1006. 3. Bradley EH, Herrin J, Wang Y, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 2006 Nov 30;355(22):2308-2320.

Table of Contents Feed for the Digital Edition of Cath Lab Digest - February 2008

Cath Lab Digest - February 2008 Bay Regional Medical Center ENDEAVOR IV: A Zotarolimus-Eluting Stent Versus a Paclitaxel-Eluting Stent in a Randomized Clinical Trial A 3D CT Vessel “Roadmap” Over Live Fluoroscopy for Chronic Total Occlusions Contents Clinical Editor’s Corner An Evaluation of Cath Lab Turnaround Time Commentary: An Evaluation of Cath Lab Turnaround Time Excerpts from Chapter 19. STEMI Interventions – Future Perspectives The Potential Clinical Utility of Intravascular Ultrasound Guidance in Patients Undergoing Percutaneous Coronary Intervention With Drug-Eluting Stents The Ten-Minute Interview with…Debbie Charlton, RN The Society of Invasive Cardiovascular Professionals (SICP) at Transcatheter Cardiovascular Therapeutics (TCT) 2007 The Cath Lab is a Business: Do You Have the Knowledge to Stay Afloat? Incidence and Predictors of Vascular Complications after Invasive Coronary Procedures: A Prospective Analysis Ask the Clinical Instructor: A Q&A Column for those New to the Cath Lab Volunteer Survey SICP* Section Meetings Calendar What Do You Think? CEU Education Center Clinical & Industry News Classifieds Advertisers Index

Cath Lab Digest - February 2008

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