Clinical Performance and Quality Measures for STEMI and NSTEMI

Authors:
Jneid H, Addison D, Bhatt DL, et al.
Citation:
2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. J Am Coll Cardiol 2017;Sep 21:[Epub ahead of print].

The following are key points to remember from the 2017 American Heart Association (AHA)/American College of Cardiology (ACC) Clinical Performance and Quality Measures for Adults With ST-Elevation (STEMI) and Non–ST-Elevation Myocardial Infarction (NSTEMI):

  1. Acute myocardial infarction (AMI) patients who survive the initial event have substantial risk for future cardiovascular events, including recurrent MI, death, heart failure, and stroke.
  2. AMI clinical performance and quality measures are designed to assess quality of care experienced by individuals who have STEMI or NSTEMI in the inpatient setting.
  3. Patients with acute STEMI (or its equivalent) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on electrocardiogram (ECG), should have first medical contact (FMC)-to-device time during primary percutaneous coronary intervention (PCI) of ≤90 minutes.
  4. Patients with acute STEMI (or its equivalent) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who are seen initially at a non–PCI-capable hospital, should be transferred to a PCI-capable hospital within door-in-door-out (DIDO) time ≤30 minutes.
  5. Patients with acute STEMI (or its equivalent) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who are transferred to a PCI-capable hospital, should receive primary PCI ≤120 minutes from FMC.
  6. Patients with acute NSTEMI who are high risk should receive an early invasive strategy (diagnostic angiography with intent to perform revascularization if appropriate based on coronary anatomy) within 24 hours of admission.
  7. Patients with AMI should be prescribed an appropriate P2Y12 receptor inhibitor at hospital discharge.
  8. Patients with AMI should be prescribed a high-intensity statin at hospital discharge.
  9. Patients with AMI who are initially conservatively managed should receive a noninvasive stress test prior to discharge.
  10. Facilities that treat patients with AMI should participate in a national or regional AMI registry that provides regular performance reports based on benchmarked data.

Clinical Topics: Acute Coronary Syndromes, Arrhythmias and Clinical EP, Dyslipidemia, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, ACS and Cardiac Biomarkers, Implantable Devices, SCD/Ventricular Arrhythmias, Nonstatins, Novel Agents, Statins, Acute Heart Failure, Heart Failure and Cardiac Biomarkers, Interventions and ACS, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: Acute Coronary Syndrome, Angiography, Biological Markers, Cardiac Catheterization, Cardiac Rehabilitation, Diagnostic Imaging, Electrocardiography, Exercise Test, Fibrinolytic Agents, Guideline, Heart Arrest, Heart Failure, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hypothermia, Induced, Myocardial Infarction, Myocardial Ischemia, Out-of-Hospital Cardiac Arrest, Percutaneous Coronary Intervention, Platelet Aggregation Inhibitors, Quality of Health Care, Reperfusion, Risk Assessment, Stroke


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