Treatment of ST Elevation MI

A periodic update on new programs offered in Interventional Cardiology at Fletcher Allen Health Care/University of Vermont

A Patient Presents with Chest Pain and ST Elevations to Your Hospital.

What Does the University of Vermont Cardiology Faculty Recommend for Therapy?

We recommend that all STEMI patients are transferred to a facility that can perform cardiac catheterization and coronary revascularization in a timely fashion by high volume interventional cardiologists. Transfer on the same day as the patient’s presentation will maximize the patient’s opportunity to receive timely revascularization and prevention of recurrent AMI.

We always accept urgent transfers 24 hours per day, 7 days per week. This includes, but is not limited to, all STEMI patients--regardless of symptomatic status. 

"What should I do prior to transfer, when the patient is still in my ER with chest pain?”

The ACC/AHA guidelines for STEMI recommend an initial strategy with thrombolytic therapy, unless the patient can have their culprit artery opened within 120 minutes of presentation to your hospital. Given the limitations of transport time in our rural environment, we support the ACC/AHA guidelines for patients with STEMI not presenting directly to our facility. Early reperfusion is a life saving treatment, and thrombolytic therapy remains the current standard of care. 

For patients in cardiogenic shock or thrombolytic contraindications, direct transfer for primary PCI is warranted, preferably with adjunctive glycoprotein IIbIIIa inhibitor prior to transfer. 

In order to prevent recurrent AMI after thrombolytic therapy, we endorse urgent PCI in all patients with < 70% resolution of ST elevation or any persistent chest pain 90 minutes after lytic therapy.  Because of delays inherent in transfer, immediate transfer after thrombolytic therapy enables early PCI in the patient with incomplete resolution of symptoms or ECG changes.