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VIEWPOINT AND COMMENTARY

ST-Segment Elevation Myocardial Infarction: Recommendations on Triage of Patients to Heart Attack Centers

Is it Time for a National Policy for the Treatment of ST-Segment Elevation Myocardial Infarction?

Timothy D. Henry, MD^_*,_*, James M. Atkins, MD, Michael S. Cunningham, MD, Gary S. Francis, MD, William J. Groh, MD, MPH^||, Robert A. Hong, MD^¶, Karl B. Kern, MD^#, David M. Larson, MD^_**, Erik Magnus Ohman, MD, Joseph P. Ornato, MD, Mary Ann Peberdy, MD, Michael J. Rosenberg, MD and W. Douglas Weaver, MD^||||

^_* Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota
Southwestern Medical Center, Dallas, Texas
Southpoint Cardiology, Jacksonville, Florida
Cleveland Clinic Foundation, Cleveland, Ohio
^|| Krannert Institute of Cardiology, Indianapolis, Indiana
^¶ John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
^# University of Arizona Medical Center, Tucson, Arizona
^_** Ridgeview Medical Center, Waconia, Minnesota
Duke University, Durham, North Carolina
Virginia Commonwealth University Health System, Richmond, Virginia
Advocate Lutheran General Hospital, Park Ridge, Illinois
^|||| Henry Ford Heart and Vascular Institute, Detroit, Michigan

Manuscript received March 2, 2005; revised manuscript received May 10, 2005, accepted May 15, 2005.

^_* Reprint requests and correspondence: Dr. Timothy D. Henry, Minneapolis Heart Institute Foundation, 920 East 28th Street, Suite 40, Minneapolis, Minnesota 55407 (Email: henry003{at}umn.edu).

Despite substantial progress in the diagnosis and treatment of acute ST-segment elevation myocardial infarction (STEMI), implementation of this knowledge into routine clinical practice has been variable. It has become increasing clear that primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion if it can be performed in a timely manner. Recent European data suggest that transfer for direct PCI may also be preferable to fibrinolytic therapy. We believe it is time to establish a national policy for treatment of patients with STEMI to develop a coordinated system of care similar to that of the level 1 trauma system.

Abbreviations and Acronyms   NRMI-2 = Second National Registry of Myocardial Infarction   PCI = percutaneous coronary intervention   STEMI = ST-segment elevation myocardial infarction

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