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Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks) 

Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks)
Chapter:
Systems of care for patients with acute ST elevation myocardial infarction (STEMI networks)
Author(s):

Kurt Huber

and Tom Quinn

DOI:
10.1093/med/9780199687039.003.0042_update_002

Update:

Added the new STEMI guidelines into the reference list

Updated on 22 February 2018. The previous version of this content can be found here.
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date: 19 October 2019

Although primary percutaneous coronary intervention is the preferred strategy for patients with ST elevation myocardial infarction, offering a fast access to this procedure often remains difficult, because of local resources and capabilities and a lack of cooperation and organization. Accordingly, for most countries worldwide, primary percutaneous coronary intervention can be provided for only part of the population. Moreover, not all patients referred for primary percutaneous coronary intervention receive an optimal mechanical reperfusion within the recommended time intervals with the procedure performed in an experienced centre by an experienced team. Intravenous thrombolytic therapy, preferably administered pre-hospital and as part of a pharmacoinvasive strategy, offers a reasonable therapeutic option in selected cases. Network organization is central to offering fast and optimal reperfusion treatment in the individual case. It has been shown repeatedly that an early recognition of ST elevation myocardial infarction, as well as minimizing time delays, is important for the achievement of optimal clinical results. These findings should encourage the building up of regional networks, according to specific local constraints, and the monitoring of their effectiveness by ongoing registries. Financial, regulatory, and political barriers can be resolved, and a prompt guideline-recommended care becomes feasible and affordable if stakeholders and participants agree and cooperate.

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