Implementation of Regional ST-Segment Elevation Myocardial Infarction Systems of Care: Successes and Challenges

Abstract

Current guidelines recommend that communities create and maintain a regional system of ST-segment elevation myocardial infarction (STEMI) care that includes assessment and continuous quality improvement of emergency medical services and hospital-based activities. Availability and timely access is a challenge in many areas of the United States. This article reviews clinical trial data supporting the use of primary percutaneous coronary intervention as the optimal reperfusion strategy, and fibrinolysis as an option when this is not possible. It then describes the outcomes and benefits of implementing regional systems of STEMI care, and discusses ongoing challenges for STEMI system implementation, including inadequate data collection and feedback, and hospital and physician competition.

Keywords: Emergency medical services; Primary percutaneous coronary intervention; Reperfusion; ST-segment elevation myocardial infarction; Systems.