Programs & Initiatives in Health Care – STEMI Systems of Care

Programs and Initiatives in Health Care
STEMI Systems of Care

Heart attack is one of the leading causes of death in Minnesota. That’s why the Minnesota Department of Health (MDH) is placing a focus on improving STEMI systems of care – to improve health outcomes for heart attack patients.

Rural Minnesota STEMI Systems of Care (PDF) – June 2017

Hospital designation

In 2016, the Minnesota Legislature gave MDH the authority to designate hospitals as STEMI Receiving Centers. Visit the page to learn more about hospital designation.

What is STEMI?

A STEMI (ST-Segment Elevation Myocardial Infarction) is the most severe type of heart attack. A heart attack or myocardial infarction happens when an artery supplying blood to the heart suddenly becomes partially or completely blocked by a blood clot. This blockage causes some of the heart muscle to die from lack of nutrients and oxygen.

Almost 250,000 Americans experience STEMI each year and about 3,000 of those people are Minnesotans. An additional 7,000 Minnesotans experience non-STEMIs each year.

Patients experiencing a STEMI need immediate emergency care to reopen the blocked artery. Presently, only a select group of large Minnesota hospitals have a cardiac catheterization laboratory that can perform the preferred treatment for STEMI.

The preferred treatment is called percutaneous coronary intervention (PCI), which physically removes the blockage using a catheter and stent to keep the artery open. If patients are unable to be treated with PCI, they will usually receive medications to break up the clot.

Why focus on systems of care?

A systems approach is the best strategy to make sure that STEMI patients are diagnosed quickly and transported to the hospital offering the most appropriate care. This starts with patients or bystanders calling 9-1-1 at the first signs of a heart attack. Most EMS agencies are able to diagnose a STEMI in the ambulance, and can determine which hospital is best able to deliver the appropriate patient care.

MDH has demonstrated success with systems-based approaches that guided the development of the Minnesota Statewide Trauma System and the Minnesota Stroke System. These systems have helped improve identification, triage, and appropriate care for patients experiencing trauma and stroke events.

MDH’s goal is to build upon those successes by ensuring that all Minnesotans have access to the highest quality STEMI care no matter where they are in Minnesota.

Learn more about STEMI systems of care from the American Heart Association's Mission Lifeline collaboration.

Some key facts:

  • Thirty percent of STEMI patients fail to receive percutaneous coronary intervention (PCI) or thrombolytic therapy
  • Of those who receive PCI, only forty percent are treated within the first medical contact-to-device timeframe of 90 minutes, recommended by the American Heart Association
  • Of those who receive thrombolytic therapy, fewer than half are treated within the recommended door-to-needle timeframe of 30 minutes­­­
  • Seventy percent of those patients who aren’t eligible for thrombolytic therapy fail to receive PCI, the only other option to restore blood flow to blocked arteries

Glossary of Terms

STEMI (ST-elevation Myocardial Infarction): This is the deadliest form of heart attack caused when an artery supplying blood to the heart is completely blocked. To reduce risk of death and disability, blood flow must be restored.

Primary PCI (Percutaneous Coronary Intervention): This is the preferred treatment for STEMI patients which involves physically opening the artery using mechanical methods. PCI is only available at large hospitals with specialized equipment and expertise. The goal is to open the blocked artery within 90 minutes of the start of the heart attack. As of summer 2015, patients experiencing STEMI in Minnesota only had access to PCI at 18 hospitals in Minnesota, or 7 hospitals close to the border in neighboring states. Most of these hospitals are concentrated in large urban centers.

Fibrinolytics: Also known as thrombolytic therapy or lytics, this is another treatment for STEMI patients available in most hospitals in Minnesota, including rural areas. It involves using drugs to dissolve the blood clot, restoring blood flow to the heart. It can be administered quickly, but works best when the patient is treated within 30 minutes of the start of their heart attack.

FMC (First Medical Contact): This is the point of first patient contact with a medical provider. For patients calling 9-1-1, this is when EMS personnel arrive. For patients arriving at the hospital emergency department by some other means, this is when the first ED provider assesses the patient.

EMS (Emergency Medical Services): EMS or Emergency Medical Services are activated by calling 9-1-1 when you suspect you or someone near you is having a heart attack.

ECG (Electrocardiogram): This procedure records the electrical activity of the heart over a period of time. A 12-lead ECG uses 12 wires and pads placed on a person’s chest and limbs. Most EMS agencies are able to administer an ECG and send the results to a physician before reaching the hospital. A doctor will diagnose the type of heart attack which will determine if the patient goes to the closest community hospital to receive thrombolytic therapy or if they are rapidly transported to a STEMI-receiving hospital for PCI.

Reperfusion: This occurs when the blocked artery has been reopened, either by PCI or by thrombolytic therapy, restoring blood flow through the previously blocked artery.