The National Institute for Health and Clinical Excellence (NICE) is in the process of developing a clinical guideline on the acute management of myocardial infarction (heart attack) with ST-segment-elevation (STEMI) and has recently issued a draft version of the guideline for public consultation.
Although the incidence of STEMI is in decline, rates still vary between regions of the UK and it still averages around 750 cases per million people each year. The incidence of in-hospital mortality after acute coronary syndromes, which includes STEMI, has also fallen from around 20% in the early 1980s to nearer 5% today. This has been attributed to various factors, including improved drug therapy and speed of access to effective treatments. In recent years mechanical techniques such as coronary angioplasty, thrombus extraction catheters and stenting have replaced fibrinolysis as the intervention of choice for improving outcomes by restoring an adequate coronary blood flow (reperfusion) as quickly as possible during the acute phase of STEMI. It is estimated that around 95% of the population in England and Wales are now covered by a Primary Percutaneous Coronary Intervention (PPCI) care pathway. The timeliness of PPCI is a crucial factor in improving outcomes successfully since nearly half of potentially salvageable myocardium is lost within one hour of the coronary artery being blocked, and two-thirds are lost within three hours. The timeliness of PPCI therefore forms a key part of this draft guideline so commissioners and those delivering services for people with STEMI can plan their configuration in such a way that outcomes are optimal.
