The two pillars of the appropriate management of patients with ST-elevation myocardial infarction (STEMI) are immediate access to defibrillation and early reperfusion. The Public Enterprise for Health Emergencies (EPES) and the Andalusian ARIAM (Analysis of the Delay in the Treatment of Acute Myocardial Infarction) Project aim to implement a common basic strategy that can be adapted to local situations in order to facilitate decision making about the treatment of these patients.
Context: The Autonomous Community of Andalusia.
Period: March-May 2006.
Participants: Professionals that attend patients with STEMI: physicians in the EPES' work group on cardiological processes, emergency department physicians, and physicians working in the intensive care units in the hospitals of the public healthcare system of Andalusia.
Approach: Levels of evidence. The levels of evidence laid out in the 2004 ACC/AHA Clinical Practice Guidelines. REACHING A CONSENSUS: A meeting was held to discuss the aspects to be included in the document. A working document was drafted and distributed to the participants via email. The final consensus document was drafted at another meeting.
Conclusions: The consensus document establishes the following priorities: 1. To apply the set of general measures recommended for the care of STEMI patients strictly and appropriately 2. To foster the use of early reperfusion in as many patients as possible, promoting the extension of fibrinolysis outside of hospitals and referral to a center with facilities for primary percutaneous coronary intervention. 3. To monitor and evaluate the management of these patients, with special attention placed on outcome and safety.