Systems of care for ST-segment elevation myocardial infarction: impact of different models on clinical outcomes

JACC Cardiovasc Interv. 2009 Oct;2(10):901-8. doi: 10.1016/j.jcin.2009.05.025.


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.

Publication types

  • Historical Article
  • Review

MeSH terms

  • Angioplasty, Balloon, Coronary* / history
  • Clinical Protocols*
  • Coronary Angiography
  • Emergency Medical Services* / history
  • Emergency Medical Services* / organization & administration
  • Europe
  • Evidence-Based Medicine
  • Health Services Accessibility* / history
  • Health Services Accessibility* / organization & administration
  • History, 20th Century
  • Humans
  • Myocardial Infarction / diagnostic imaging
  • Myocardial Infarction / history
  • Myocardial Infarction / therapy*
  • National Health Programs
  • North America
  • Organizational Objectives
  • Outcome and Process Assessment, Health Care* / history
  • Patient Admission
  • Patient Care Team* / history
  • Patient Care Team* / organization & administration
  • Quality Indicators, Health Care
  • Randomized Controlled Trials as Topic
  • Regional Health Planning* / history
  • Regional Health Planning* / organization & administration
  • Thrombolytic Therapy / history
  • Time Factors
  • Treatment Outcome