The UK’s National Institute for Health and Clinical Excellence (NICE) has published the draft version of its guidance for the acute management of ST-segment-elevation myocardial infarction (STEMI) as part of its public consultation process
The timeliness of primary percutaneous coronary intervention (PPCI) forms a key part of the draft guideline so commissioners and those delivering services for people with STEMI can plan their configuration in such a way that outcomes are optimal. This guideline also covers the use of antiplatelet and antithrombin agents, and improving outcomes for the minority of people still receiving fibrinolysis.
As its starting point, the draft guideline recommends that all people with acute STEMI are immediately assessed for their eligibility for coronary reperfusion therapy (either PPCI or fibrinolysis). Other draft key recommendations in the guideline include:
• Do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to determine whether a person is eligible for coronary angiography (with follow-on PPCI if indicated).
• Offer coronary angiography, with follow-on PPCI if indicated, as the preferred coronary reperfusion strategy for people with acute STEMI if: presentation is within 12 hours of onset of symptoms, and PPCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.
• Offer fibrinolysis to people with acute STEMI presenting within 12 hours of onset of symptoms if PPCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given.
• When commissioning PPCI services for people with acute STEMI, be aware that outcomes are strongly related to how quickly PPCI is delivered, and that they can be influenced by the number of procedures carried out by the PPCI centre.
Professor Mark Baker, director of the Centre for Clinical Practice at NICE, said: “The guideline development group has carefully weighed all the current evidence and have come up with a set of recommendations that have at their core the need to ensure that there should be a single reperfusion pathway for people with STEMI in each locality that should work consistently and be reproducible for all people, both within and outside normal working hours. A great deal has been done to improve outcomes for people who have had an acute STEMI; this guideline identifies how outcomes can be improved even further.”
Stakeholders have until 22 March 2013 to comment on the recommendations in the draft guideline. Organisations can register as stakeholders at any time during the development of the guideline and comments must be submitted via the NICE website; www.nice.org.uk. Until the final guideline is published, recommendations could change depending on feedback received during the development of this guideline.
