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New Guidelines for Treating Severe Heart Attack

Coronary intervention with balloon angioplasty and stents is preferred therapy (Dec. 17)

New streamlined guidelines have been issued by the American Heart Association and the American College of Cardiology to help healthcare providers better treat patients with the most severe type of heart attacks. The guidelines were published online in Circulation and in 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 Dr. 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 that can lead to cardiac arrest — and heart failure as a result of the loss of a large amount of heart muscle. Approximately 250,000 Americans experience STEMI each year.

The new 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 receive immediate treatment, and rapid restoration of blood flow in the obstructed coronary artery.

According to the guidelines, percutaneous coronary intervention (PCI) — which comprises balloon angioplasty to open a clogged artery and stents to keep it open — is the preferred treatment strategy for STEMI 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 they are safe for the patient, followed by transfer to a facility where an intervention can be performed if needed.

Other key topics in the guidelines include:

  • Improving patient recognition of heart attack symptoms and the importance of immediately calling 911. Patient delay in reporting symptoms is one of the greatest obstacles to timely and successful care. Travel by private car to the hospital is strongly discouraged.
  • Recommending that emergency medical technicians perform electrocardiograms in the field to facilitate more rapid triage and speedier treatment.
  • Using hypothermia (cooling) to treat patients who experience cardiac arrest. To reduce brain injury in these patients, cooling protocols should be activated before or at the same time as cardiac catheterization.
  • Providing care plans when the patient is discharged after STEMI. These plans should be clearly communicated and shared with patients, families, and other healthcare 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.

Source: American Heart Association; December 17, 2012.

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