STEMI Definition
In the absence of LBBB or LVH New ST elevation at the J point in at least 2 contiguous leads of: 2 mm (0.2 mV) in men or 1.5 mm (0.15 mV) in women in leads V2–V3 and/or of 1 mm (0.1 mV) in other contiguous chest leads or the limb leads ST depression in 2 precordial leads (V1–V4) may indicate transmural posterior injury
STEMI Definition Caveats Most cases of LBBB at time of presentation are “not known to be old” because of ECG is not available for comparison. New or presumably new LBBB at presentation occurs infrequently Interfere with ST-elevation analysis, and Should not be considered diagnostic of acute MI in isolation Baseline ECG abnormalities other than LBBB (LVH, Brugadda, V paced) obscure STEMI assessment
Jain et al. Am J Cardiol 2011;107: 1111–1116
7 Hospitalizations in the U.S. Due to Acute Coronary Syndromes (ACS) Acute Coronary Syndromes* 1.57 Million Hospital Admissions - ACS UA/NSTEMI † STEMI 1.24 million Admissions per year.33 million Admissions per year Heart Disease and Stroke Statistics – 2007 Update. Circulation 2007; 115: *Primary and secondary diagnoses. †About 0.57 million NSTEMI and 0.67 million UA.
STEMI Epidemiology
STEMI Facts In hospital and 1 year mortality continue to decline Reperfusion therapy Earlier recognition “Time is myocardium” Target Areas For Improvement Women, Non-whites, Diabetics, Elderly, CKD/ESRD
STEMI Timeline
STEMI Guidelines – Cath Activation
STEMI Guidelines
Platelets Role in Thrombosis Reproduced with permission from Cannon CP. Atherothrombosis slide compendium. Available at: Aggregation 3 1 Activation 2 Adhesion
Pathways to Clot Formation White HD. AM J Cardiol 1997; 80:2B-10B Schafer A. J Clin Invest 1986; 78:73-79 DeJong MJ, et al. Critical Care Nursing Clin of N Am 1999; 11:
STEMI Guidelines - Fibrinolytic
STEMI Guidelines - Hypothermia
STEMI Guidelines - Anticoagulation
An Electrical Beat
Many faces of normal ST segments
Pathologic ST segments
ECG
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