In-Hospital ST-Segment Elevation Myocardial Infarction: Improving Diagnosis, Triage, and Treatment

JAMA Cardiology
Glenn N LevineIn-Hospital STEMI Quality Improvement Project

Abstract

In-hospital ST-segment elevation myocardial infarction (STEMI) is a unique clinical entity with epidemiology, incidence, and outcomes distinct from that of out-of-hospital STEMI and has only within the past 10 years begun to receive increased attention and research. Patients with in-hospital STEMI are older, have more comorbidities, and more frequently have coagulopathies and contraindications for anticoagulation and fibrinolytic therapy. A standardized clinical definition of in-hospital STEMI is lacking. The objectives of this special communication are to (1) summarize the knowledge base regarding in-hospital STEMI; (2) review the challenges of diagnosis and treatment of patients with in-hospital STEMI; (3) present a standardized clinical definition for in-hospital STEMI; and (4) provide a quality improvement protocol to improve diagnosis, triage, and treatment of patients with in-hospital STEMI. Patients with in-hospital STEMI less frequently present with typical angina symptoms, and an electrocardiogram is often obtained owing to changes in clinical status, changes on telemetry, or a finding of elevated cardiac biomarker. The frequent nontypical presentations often lead to substantial delays in the diagnosis of STEMI. Only 3...Continue Reading

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Citations

Jan 19, 2019·JAMA Network Open·Steven M BradleyStephan D Fihn
Sep 27, 2019·Experimental and Therapeutic Medicine·Liyuan ZouChaoquan Peng
Nov 8, 2020·Clinical Cardiology·Negeen ShahandehMarcella Calfon Press
Jun 1, 2021·Interventional Cardiology Clinics·Alayn GoveaMitul P Patel

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