STEMI (ST-segment elevation myocardial infarction) is a medical emergency and one of the deadliest forms of heart attack. The relationship between reperfusion and survival in STEMI patients can be measured in minutes. Primary percutaneous coronary intervention (PCI) is now the dominant reperfusion strategy for these patients.
Since 2004, the University of Ottawa Heart Institute’s (UOHI) Regional STEMI Program’s protocols and pathways provide timely access to PPCI giving STEMI patients within the city of Ottawa the best chance of survival. STEMI patients are referred via the paramedic-referred pathway (field) or the inter-hospital transfer pathway. Current guidelines recommend achieving a door-to-balloon time (i.e., revascularization) of less than 90 minutes for patients presenting to a PCI capable hospital and of less than 120 minutes for patients referred by inter-hospital transfer to a PCI hospital.
The program operates 24/7 and has expanded to include many hospitals outside the boundaries of the city. The furthest community hospital included within the primary PCI circle is Renfrew Victoria Hospital located 90 km from the Heart Institute.
Still, many patients who present with STEMI within the Champlain Local Health Integrated Network (LHIN) cannot feasibly undergo primary PCI in a timely fashion. Therefore, since 2008, the STEMI Program also encompasses a pharmacoinvasive pathway in which STEMI patients receive fibrinolytic therapy, unless contraindicated. Following administration of fibrinolytic therapy, the referring hospital arranges for immediate transfer by ambulance to the Heart Institute. Cardiac catheterization is performed within 24 hours of arrival or immediately if clinically indicated. This pathway has been developed for hospitals which are located at a distance that would otherwise not achieve guideline door-to-balloon times as needed for primary PCI. The furthest hospital included within the pharmacoinvasive circle is Deep River & District Hospital located 188 km from the Heart Institute.
Since the launch of the STEMI program, heart attack deaths have been reduced by 50% in the Ottawa region and these findings have been published in The New England Journal of Medicine (2008). To this day, the UOHI Regional STEMI Program serves as a model for other regions in Canada.
Dr. Michel Le May, would like to acknowledge, on behalf of the STEMI Program, the physicians, nurses and support staff of the University of Ottawa Heart Institute, the Champlain LHIN Emergency Departments and the Emergency Management Services for their dedication and continuous participation in the program. Their ongoing commitment has made this program a realization and a great success.