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Systems of Care for ST-Segment Elevation Myocardial Infarction

Impact of Different Models on Clinical Outcomes

Department of Cardiology, European Hospital Georges Pompidou of Paris, Paris, France

^_* Reprint requests and correspondence: Dr. Nicolas Danchin, Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance Publique Hôpitaux de Paris, Université Paris Descartes, 20 rue Leblanc, 75015 Paris, France (Email: nicolas.danchin{at}egp.aphp.fr).

ST-segment elevation myocardial infarction (STEMI) is one of the greatest medical emergencies, for which organization of care has a determinant impact on patient outcomes. The purpose of this paper is to review systems of care for STEMI patients. Although primary percutaneous coronary intervention (PCI) is the preferred option for patients with STEMI, offering easy and emergent access to this procedure often remains difficult because of geographic and diverse structural difficulties. intravenous fibrinolysis, especially when administered early after symptom onset and as part of a pharmacoinvasive strategy (i.e., followed by rapid coronary angiography with PCI when necessary), offers a reasonable therapeutic option in selected cases and has yielded satisfactory clinical results. Network organization is central for optimizing patient care at the acute stage of myocardial infarction. This review describes different clinical experiences with network implementation both in Europe and in North America. In all instances, early recognition of STEMI and, particularly in the pre-hospital setting, shortening time delays is central for the achievement of optimal clinical results. Overall, the encouraging results described in the models presented here, as diverse as they might be, should be an encouragement to promote and implement regional protocols according to the specific local constraints and to monitor their effectiveness by recording simple quality indicators in ongoing registries.

Key Words: PCI • reperfusion • STEMI

Abbreviations and Acronyms   DB = door-to-balloon   ECG = electrocardiogram   MICU = mobile intensive care unit   PCI = percutaneous coronary intervention   PPCI = primary PCI   SAMU = Service d'Aide Médicale Urgente   STEMI = ST-segment elevation myocardial infarction