Latest news with #STEMI
Medscape
6 days ago
- Health
- Medscape
Missed Target Treatment Times May Increase MI Mortality
When it comes to delivering timely treatment for patients experiencing myocardial infarction (MI), many hospitals are continuing to fall short of national guidelines, new research showed. Benchmarks for percutaneous coronary intervention, the standard of care for acute ST-elevation MI (STEMI), aren't being met in some cases. Delays in care in the key metric of the time from first contact with medical care to angioplasty with stenting resulted in worse patient outcomes and were associated with increased in-hospital mortality risk in some cases, according to the findings, published on June 11 in JAMA Cardiology . 'There are two categories of patient delays: Those that are patient-centered and those that are system-centered,' said Neal S. Kleiman, MD, Houston Methodist DeBakey Heart and Vascular Center, Houston, the senior author of the new study. 'We don't have control over patient-related factors, but there is a lot we can do in terms of hospital systems.' For the retrospective cross-sectional study, Kleiman and his colleagues analyzed data on 73,826 patients with STEMI or STEMI equivalent from 503 sites across the United States. The goal was to determine site-level variability in patterns of treatment times and clinical outcomes from 2020 to 2022 based on an analysis of data from the American Heart Association's Get With the Guidelines — Coronary Artery Disease registry — a quality improvement program for patients with coronary artery disease, acute MI and chest pain. The authors said the study is the first large-scale analysis of treatment goals and outcomes in STEMI based on hospital performance. The researchers found an association between failure to reach the target time from first medical contact with care to angioplasty with stenting — 90 minutes or less — and increased risk for in-hospital mortality for primary presentations and transfers (adjusted odds ratio, 2.21; 95% CI, 2.02-2.42, and 2.44; 95% CI, 1.90-3.12, respectively). Low-performing hospitals were associated with increased risk for mortality and longer stays in the hospital than were high-performing hospitals. However, hospital location and case volume were not associated with worse outcomes. The guidelines recommend a target time from first contact with care to angioplasty with stenting of 90 minutes or less for patients presenting directly to hospitals offering angioplasty with stenting and 120 minutes or less for patients requiring transfer to a facility offering the procedure. The study findings revealed significant variability between hospital sites in meeting the key metric of the recommendations — adherence in at least 75% of patients with STEMI. At hospitals with the capability to perform angioplasty with stenting, the target was met in 72.2% of patients at high-performing sites, 60.8% at intermediate-performing sites, and 46.0% at low-performing sites. When patients required transfers to other facilities with the capability to perform angioplasty, a target first medical contact-to-device treatment time of 120 minutes or less was achieved in 72.3% of patients at high-performing sites, 48.8% at intermediate performing sites, and 21.9% at low-performing sites, according to the researchers. In these hospitals, treatment delays were caused primarily by longer stays in the emergency department and time from arrival in the catheterization laboratory to stenting. Limitations of the study included the fact registry responses were provided on a voluntary basis and may not reflect the totality of STEMI care in all geographical areas, according to the researchers. The analysis also lacked data on follow-up after discharge, making it difficult to extrapolate the findings over the long term, they said. Yasser M. Sammour, MD, MSc, cardiology fellow at Houston Methodist DeBakey Heart and Vascular Center, who led the work, said several decades of research have highlighted the importance of treating patients with STEMI efficiently. A previous registry study found fewer treatment delays were linked to reduced mortality. 'The current study tried to take that research one step further, assessing how factors such as hospital performance and location affect patient outcomes,' Sammour said. The result, he said: 'We're still underperforming. We need to have coordinated strategies with local intervention at the hospital level to examine where significant delays in percutaneous coronary intervention time are occurring.' The absence of uniformity in established performance measures such as time to initiate treatment in STEMI has led to calls for greater adherence to current recommendations. In an editorial accompanying the journal article, Roxana Mehran, MD, Mount Sinai Fuster Heart Hospital in New York City, wrote: 'After two decades of data collection, national initiatives, and public accountability, the next step must involve tailored solutions addressing barriers within each institution. Bridging the gap now requires renewed efforts and commitments to prioritize timely, coordinated STEMI care. Until then, the clock will continue to tick — against our patients.'
The Hindu
14-06-2025
- Health
- The Hindu
Hyderabad hospital bags certification from American Heart Association
Apollo Hospitals, Jubilee Hills, Hyderabad, has been awarded the Comprehensive Chest Pain Centre Certification by the American Heart Association (AHA). The certification is awarded to hospitals that meet standards in the rapid assessment, diagnosis and treatment of chest pain, especially in critical cases such as ST-Elevation Myocardial Infarction (STEMI), a severe form of heart attack, said the hospital in a release. 'Cardiovascular diseases remain the leading cause of death globally, accounting for 32% of all fatalities. In India, nearly 36% of adult deaths between the ages of 30 and 69 are due to heart disease,' said Tejesvi Rao, CEO, Apollo Hospitals, Telangana Region.
Time of India
08-06-2025
- Health
- Time of India
Tenecteplase injection saves 2,650 lives in Andhra Pradesh under STEMI
1 2 3 Visakhapatnam: Under the STEMI (ST-elevated myocardial infarction) programme, which aims to enable treatment for heart attacks during the critical golden hour, Tenecteplase injections costing approximately Rs 45,000 are being provided free of charge to eligible patients in Andhra Pradesh. This initiative by the state health department has so far saved around 2,650 lives since the programme's inception about 10 months ago. According to experts, thrombolytic therapy using Tenecteplase is crucial during the golden hour for patients experiencing acute myocardial infarction. The golden hour represents the vital window during which immediate medical intervention can significantly improve patient outcomes. This clot-dissolving medication works by breaking down blood clots that obstruct blood flow to the heart. State health minister Satya Kumar Yadav said that the costly injection is being provided free of charge to patients, which has helped save 2,650 lives. "I appreciate all the stakeholders involved in this STEMI mission," Yadav added. When administered properly, Tenecteplase helps restore blood flow through blocked arteries. The earlier the treatment, the better the chance of preserving heart muscle and reducing mortality. Similarly, in cases of ischaemic stroke, prompt administration of Tenecteplase within the approved time window is essential to avoid permanent brain damage. Dr K Rambabu, director of the Visakha Institute of Medical Sciences (VIMS), explained that approximately 40 mg is administered to patients with myocardial infarction (MI), while 20 mg is used for those suffering from ischaemic stroke. "After stabilising myocardial infarction patients with this thrombolytic therapy at VIMS, they are referred to hospitals equipped with cath labs. Stroke patients, however, are treated at VIMS itself. Thanks to the govt, the free injection is a blessing for poor patients. It facilitates recovery during the critical golden hour. VIMS has requested the establishment of a cath lab, which would not only aid in treating MI patients but also allow advanced procedures such as embolisation," Dr Rambabu said. Ch Jagannadha Rao, a 70-year-old patient, shared his experience after being admitted to VIMS for right-sided weakness in both upper and lower limbs (stroke). "I noticed my mouth was deviating to the left, and I was slurring my speech. The doctors told me a CT scan showed no haemorrhage. They administered a Tenecteplase injection, and within an hour, I noticed improvement in my right limbs and speech. They continued my treatment with other medications. After five days, I could walk unaided and speak normally. I was discharged after nine days, fully recovered," Rao said. The STEMI programme operates under a hub-and-spoke model. Major hospitals function as hubs, while selected community health centres, area hospitals, and district hospitals are connected to these hubs and serve as 'spokes'. If a person experiences chest pain, they can visit the nearest smaller hospital (a spoke), where doctors perform an ECG. Senior specialists at the hub then review the data and determine if the Tenecteplase injection is required. If so, doctors at the spoke administer it immediately, and the patient is subsequently transferred to the hub for further treatment.
Time of India
30-05-2025
- Health
- Time of India
‘STEMI to ensure no heart patient in UP dies due to lack of treatment'
1 2 3 4 5 6 Lucknow: Heart patients in UP will soon be able to receive timely treatment at their nearest district hospital or community health centre, with the 'System of Treating Elevation Myocardial Infarction' (STEMI) care network. The initiative aims to provide advanced cardiac care during the critical 'golden hour' following a heart attack, increasing the chances of survival for patients even in remote areas. To support this, a three-day Training of Trainers (ToT) workshop began at Ram Manohar Lohia Institute of Medical Sciences (RMLIMS). The workshop is focused on training healthcare professionals, including doctors, staff nurses, and paramedics, to implement standardised STEMI protocols in their respective districts. These protocols are designed to ensure early diagnosis, prompt administration of medication, and timely patient transfer to higher centres when needed. Inaugurating the workshop, principal secretary of medical health & family welfare and medical education, Partha Sarthi Sen Sharma, emphasised the govt's vision of expanding emergency cardiac services across the state. He assured that there would be no shortage of Tenecteplase, the clot-dissolving drug used in heart attack cases, and that it would be made available even at the most remote healthcare centres. "Our goal is to ensure that no patient in Uttar Pradesh loses their life due to the non-availability of timely heart attack treatment," he said. The STEMI care network is based on a hub-and-spoke model. RMLIMS, through its cardiology department, will function as the central hub providing specialist oversight, ECG interpretation, and advanced intervention facilities. District hospitals in Ayodhya, Devipatan range, Sultanpur, and other regions will serve as spoke hospitals. These centres will be responsible for early diagnosis and initiation of treatment under the guidance of the hub. Dr Bhuwan Tiwari, head of cardiology at RMLIMS, explained the structure of the STEMI CARE protocol during the workshop. He introduced a step-by-step acronym that guides healthcare providers in managing heart attack patients. "The power of this program lies in empowering frontline health workers to act swiftly and correctly," he said. The acronym STEMI CARE stands for: Symptoms (identify cardiac symptoms), Time (note when symptoms started), ECG (perform and interpret a 12-lead ECG), Medical Management (give aspirin, clopidogrel, and atorvastatin), Initiate Thrombolysis (administer Tenecteplase if needed), Call the Hub (share patient data with the tertiary centre), Ambulance (arrange transfer with oxygen and IV access), Reassess (monitor vitals before transfer), and Ensure Handover (send referral documents with the patient). Senior cardiologist Dr Rishi Sethi from KGMU spoke about the clinical importance of timely STEMI care'. Varanasi CMO Dr Sandeep Chaudhary shared practical experiences from the field.
Medscape
27-05-2025
- Business
- Medscape
In 10 Years, No Big Gains With Deferred Stenting in STEMI?
A 10-year follow-up study confirmed that compared with conventional immediate percutaneous coronary intervention (PCI), deferred stenting in patients with ST-segment elevation myocardial infarction (STEMI) did not reduce the composite of all-cause mortality or hospitalisation for heart failure (HF) but was associated with a reduction in hospitalisation for HF. METHODOLOGY: The multicentre DANAMI-3-DEFER trial in Denmark (March 2011 to February 2014) found no significant clinical benefits of deferred stenting over conventional PCI with immediate stenting for patients with STEMI; rather, it was associated with an increased risk for target vessel revascularisation. Researchers conducted a post hoc analysis of the trial to assess 10-year outcomes, evaluating 1215 patients with STEMI and acute chest pain for less than 12 hours from symptom onset. Patients were randomly assigned to receive either deferred stenting (n = 603), performed 24-48 hours after the initial PCI, or conventional PCI (n = 612), involving stent placement immediately after PCI. The primary outcome was a composite of hospitalisation for HF or all-cause mortality. TAKEAWAY: The 10-year cumulative incidence of hospitalisation for HF or all-cause mortality was not significantly different between patients in the deferred stenting group and those in the conventional PCI group. Hospitalisation for HF was 42% lower in the deferred stenting group than in the conventional PCI group (odds ratio, 0.58; P = .010). = .010). No significant differences in target vessel revascularisation were observed between the two groups. IN PRACTICE: "Unlike earlier findings, the extended follow-up showed that the increased incidence of target vessel revascularization in the deferred stenting group observed in the DANAMI-3-DEFER main trial appeared to diminish in the long-term," the authors of the study wrote. SOURCE: This study was led by Jasmine Melissa Marquard, MD, Copenhagen University Hospital, Copenhagen, Denmark. It was published online on May 20, 2025, in Circulation: Cardiovascular Interventions . LIMITATIONS: Owing to the open-label design of this trial, patients and treating physicians were aware of the treatments, which might have introduced biases. The findings should be interpreted with caution, especially considering the small sample size and the post hoc nature of the analysis. DISCLOSURES: The DANAMI-3-DEFER trial received funding from the Danish Agency for Science, Technology and Innovation and the Danish Council for Strategic Research. Additional disclosures are noted in the original article. Several authors reported receiving honoraria, advisory board fees, speaker fees, and grants from multiple pharmaceutical and medical technology companies, including AstraZeneca, Novartis, and Biotronik.
