THE MANAGEMENT OF ACUTE MYOCARDIAL INFARCTION IN PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION (STEMI)

Domain 1: Centre organization

1.     The center should be part of a network organization with written protocols for rapid and efficient management

2.     Pre-hospital interpretation of ECG for: 1) diagnosis, 2) decision for immediate transfer to a center with catheterization laboratory facilities, and 3) pre-hospital activation of the catheterization laboratory

3.     The center should participate in a regular registry or program for quality assessment

4.     Routine assessment of relevant times for the reperfusion process in STEMI patients (i.e., times from ‘call to first medical contact’, ‘first medical contact to arrival at PCI center, arrival at PCI center to arterial access)

Domain 2 : Reperfusion/Invasive strategy

5.     Proportion of patients with STEMI reperfused among those eligible (onset of symptoms to diagnosis <12 h).

6.     Proportion of patients with STEMI who receive timely reperfusion. Timely is defined as: 1) For patients presenting at primary PCI hospitals: <60 min from initial STEMI diagnosis to infarct-related artery wire crossing 2) For patients diagnosed either in a non-PCI hospital or in the out-of-hospital setting and then transferred to a PCI capable center: <90 min from initial STEMI diagnosis to infarct-related artery wire crossing 3) For patients treated with fibrinolysis, initiation of fibrinolysis within 10 minutes after STEMI diagnosis

7.     Use of radial access in case of invasive Strategy

8.     The time between the initial STEMI diagnosis and arterial access (absolute value) for primary PCI.

Domain 3: In-hospital risk assessment

9.     The proportion of patients who have an assessment of LVEF before hospital discharge (LVEF should be assessed and the numerical value recorded for all patients).

10.  LDL-Cholesterol assessment should be performed during hospitalization

11.  Ischemic and hemorrhagic risk assessment should be performed using a validated risk score.

Domain 4: Anti-thrombotic treatment during hospitalization

12.  Proportion of patients with “adequate P2Y12 inhibition” defined as: (number of patients discharged with prasugrel, ticagrelor, or clopidogrel)/(patients eligible). Eligible is defined as follows:

13.  For ticagrelor: AMI patients without previous hemorrhagic stroke, high bleeding risk, fibrinolysis or oral anticoagulation. 

14.  For prasugrel: PCI-treated AMI patients without previous hemorrhagic or ischaemic stroke, high bleeding risk (patients ≥75 years and/or <60 kg body weight is also considered as high bleeding risk features), fibrinolysis or oral anticoagulation.

15.  For clopidogrel: no indication for prasugrel or ticagrelor and no high bleeding risk.

16.  Patients discharged on dual antiplatelet Therapy

17.  Mention the duration of the dual antiplatelet therapy in the discharge letter

Domain 5 : Secondary prevention discharge treatments

18.  Proportion of patients discharged from hospital on high intensity statins (defined as atorvastatin ≥40 mg or rosuvastatin ≥20 mg) unless contraindicated

19.  Proportion of patients with LVEF <40% who are discharged from hospital on ACEI (or ARBs if intolerant of ACEI).

20.  Proportion of patients with LVEF <40% who are discharged from hospital on betablockers

Domain 6: Patient satisfaction

21.  Feedback regarding the patient’s experience systematically collected in an organized way from all patients. It should include the following points:

·       Recommendation to attend an educational program (rehabilitation, smoking cessation, weight control and diet counselling).

·       Explanations provided by doctors and nurses (about the coronary disease, the benefit/risk of the discharge treatment, and medical follow-up).

·       Discharge information regarding what to do in case of recurrence of symptoms and timing of visit.

·       Pain control.

22.  Systematic assessment of health-related quality of life in all patients using a validated instrument.

23.  The discharge letter should be sent to the Patient

Domain 7: Outcomes

24.  Risk adjusted 30-day mortality rate