ST-segment elevation myocardial infarction (STEMI) is a form of heart attack that can cause death if not treated quickly. Approximately one-third of acute coronary syndromes are classified as STEMI (Fitchett, 2011). Data from the Canadian Institute for Health Information (CIHI) Discharge Abstract Database (DAD) suggest that the incidence of STEMI in Ontario is approximately 68 of every 100,000 adult residents, a total of about 7,000 STEMIs per year.
STEMIs are treated through the restoration of blood flow in the coronary artery through one of two treatment options or “reperfusion” modalities:
- Percutaneous coronary intervention (PCI), a procedure in which the coronary arteries are mechanically reopened using a balloon or aspiration catheter and the placement of a stent in the blocked arteries.
- Clot-busting drugs (i.e., fibrinolysis therapy).
Timely reperfusion requires timely diagnosis, transportation and treatment when STEMI is diagnosed or suspected, and the timeliness of the intervention is measured in minutes. The Canadian Cardiovascular Society (CCS) and American College of Cardiology/ American Heart Association (ACC/AHA) guidelines recommend that STEMI patients treated by primary PCI presenting to a PCI capable hospital have a door-to-balloon (D2B) time of less than 90 minutes and patients treated with fibrinolysis therapy have a door-to-needle (D2N) time of less than 30 minutes; patients presenting to a non-PCI capable hospital should have a D2B time of less than 120 minutes (CCS 2004,ACC/AHA 2013).