VIEWPOINT AND COMMENTARY
Time Is MuscleTranslation Into Practice
Elliott M. Antman, MD, FACC*
TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts
Manuscript received June 4, 2008;
revised manuscript received July 2, 2008,
accepted July 11, 2008.
* Reprint requests and correspondence: Dr. Elliott M. Antman, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115 (Email: eantman{at}rics.bwh.harvard.edu).
In the future, advances in the care of patients with ST-segment elevation myocardial infarction (STEMI) will not come from the analysis of trials that do not reflect current practice in an effort to rationalize extending the percutaneous coronary intervention (PCI)-related delay time. We must move beyond such arguments and find ways to shorten total ischemic time. With the launching of the American College of Cardiology's D2B Alliance and the American Heart Association's Mission: Lifeline programs, the focus is now on systems improvement for reperfusion in patients with STEMI. The D2B Alliance was developed to focus on improvement in door-to-balloon times for patients with STEMI who are undergoing primary PCI. The American Heart Association Mission: Lifeline program is a broad, comprehensive national initiative to improve the quality of care and outcomes of patients with STEMI by improving health care system readiness and response to STEMI. Improvements in access to timely care for patients with STEMI will require a multifaceted approach involving patient education, improvements in the Emergency Medical Services and emergency department components of care, the establishment of networks of STEMI-referral hospitals (not PCI capable) and STEMI-receiving hospitals (PCI capable), as well as coordinated advocacy efforts to work with payers and policy makers to implement a much-needed health care system redesign. By focusing now on system efforts for improvements in timely care for STEMI, we will complete the cycle of research initiated by Reimer and Jennings 30 years ago. Time is muscle ... we must translate that into practice.
Key Words: ST-segment elevation myocardial infarction • reperfusion • guidelines
|
Abbreviations and Acronyms
| | ACC = American College of Cardiology | | AHA = American Heart Association | | D2B = door-to-balloon | | EMS = Emergency Medical Services | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction |
|
Related Article
-
Inside This Issue of JACC
J. Am. Coll. Cardiol. 2008 52: A32.
[Full Text]
[PDF]
This article has been cited by other articles:
|
|
|
|
 
R. Mathews, E. D. Peterson, S. Li, M. T. Roe, S. W. Glickman, S. D. Wiviott, J. F. Saucedo, E. M. Antman, A. K. Jacobs, and T. Y. Wang
Use of Emergency Medical Service Transport Among Patients With ST-Segment-Elevation Myocardial Infarction: Findings From the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines
Circulation,
July 12, 2011;
124(2):
154 - 163.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. W. Glickman, B. L. Lytle, F.-S. Ou, G. Mears, S. O'Brien, C. B. Cairns, J. L. Garvey, D. J. Bohle, E. D. Peterson, J. G. Jollis, et al.
Care Processes Associated With Quicker Door-In-Door-Out Times for Patients With ST-Elevation-Myocardial Infarction Requiring Transfer: Results From a Statewide Regionalization Program
Circ Cardiovasc Qual Outcomes,
July 1, 2011;
4(4):
382 - 388.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Martinoni, S. D. Servi, E. Boschetti, R. Zanini, T. Palmerini, A. Politi, G. Musumeci, G. Belli, M. D. Paolis, F. Ettori, et al.
Importance and limits of pre-hospital electrocardiogram in patients with ST elevation myocardial infarction undergoing percutaneous coronary angioplasty
European Journal of Cardiovascular Prevention & Rehabilitation,
June 1, 2011;
18(3):
526 - 532.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. V. Finn, M. Nakano, J. Narula, F. D. Kolodgie, and R. Virmani
Concept of Vulnerable/Unstable Plaque
Arterioscler Thromb Vasc Biol,
July 1, 2010;
30(7):
1282 - 1292.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. A. Spencer, G. Montalescot, K. A. A. Fox, S. G. Goodman, C. B. Granger, R. J. Goldberg, G. B. F. Oliveira, F. A. Anderson, K. A. Eagle, G. Fitzgerald, et al.
Delay to reperfusion in patients with acute myocardial infarction presenting to acute care hospitals: an international perspective
Eur. Heart J.,
June 1, 2010;
31(11):
1328 - 1336.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Spertus
Broadening Our Understanding of Survival After Myocardial Infarction: The Association of Neighborhood With Outcomes
Circulation,
January 26, 2010;
121(3):
348 - 350.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Francone, C. Bucciarelli-Ducci, I. Carbone, E. Canali, R. Scardala, F. A. Calabrese, G. Sardella, M. Mancone, C. Catalano, F. Fedele, et al.
Impact of Primary Coronary Angioplasty Delay on Myocardial Salvage, Infarct Size, and Microvascular Damage in Patients With ST-Segment Elevation Myocardial Infarction: Insight From Cardiovascular Magnetic Resonance
J. Am. Coll. Cardiol.,
December 1, 2009;
54(23):
2145 - 2153.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
J. Am. Coll. Cardiol.,
December 1, 2009;
54(23):
2205 - 2241.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. G. Kushner, M. Hand, S. C. Smith Jr, S. B. King III, J. L. Anderson, E. M. Antman, S. R. Bailey, E. R. Bates, J. C. Blankenship, D. E. Casey Jr, et al.
2009 Focused Updates: ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (Updating the 2004 Guideline and 2007 Focused Update) and ACC/AHA/SCAI Guidelines on Percutaneous Coronary Intervention (Updating the 2005 Guideline and 2007 Focused Update): A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Circulation,
December 1, 2009;
120(22):
2271 - 2306.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. J. Kumbhani, C. P. Cannon, G. C. Fonarow, L. Liang, A. T. Askari, W. F. Peacock, E. D. Peterson, D. L. Bhatt, and for the Get With the Guidelines Steering Committee
Association of Hospital Primary Angioplasty Volume in ST-Segment Elevation Myocardial Infarction With Quality and Outcomes
JAMA,
November 25, 2009;
302(20):
2207 - 2213.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. J. Terkelsen, J. T. Sorensen, T. T. Nielsen, and E. Boersma
Percutaneous Coronary Intervention Related Delay in ST-Segment Elevation Myocardial Infarction Patients
J. Am. Coll. Cardiol.,
April 7, 2009;
53(14):
1244 - 1244.
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. M. Antman
Reply
J. Am. Coll. Cardiol.,
April 7, 2009;
53(14):
1244 - 1245.
[Full Text]
[PDF]
|
|
|
|
|
|
|
I. C. Rokos, W. J. French, W. J. Koenig, S. J. Stratton, B. Nighswonger, B. Strunk, J. Jewell, E. Mahmud, J. V. Dunford, J. Hokanson, et al.
Integration of Pre-Hospital Electrocardiograms and ST-Elevation Myocardial Infarction Receiving Center (SRC) Networks: Impact on Door-to-Balloon Times Across 10 Independent Regions
J. Am. Coll. Cardiol. Intv.,
April 1, 2009;
2(4):
339 - 346.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. N. DeMaria, O. Ben-Yehuda, J. J. Bax, G. K. Feld, B. H. Greenberg, W. Y.W. Lew, J. A.C. Lima, A. S. Maisel, S. M. Narayan, D. J. Sahn, et al.
Highlights of the Year in JACC 2008
J. Am. Coll. Cardiol.,
January 27, 2009;
53(4):
373 - 398.
[Full Text]
[PDF]
|
|
|
|
