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Can J Cardiol. 2019 Feb;35(2):107-132. doi: 10.1016/j.cjca.2018.11.031.

2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion.

Author information

1
Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: gcwong@mail.ubc.ca.
2
Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
3
Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada.
4
Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
5
Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
6
McGill University Health Centre, McGill University, Montréal, Québec, Canada.
7
Institut National d'Excellence en Santé et en Services Sociaux, Montréal, Québec, Canada.
8
The University of Ottawa Heart Institute, University of Ottawa, Ottawa, Ontario, Canada.
9
New Brunswick Heart Centre, Dalhousie University, Halifax, Nova Scotia, Canada.
10
Mazankowski Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
11
University Health Network, University of Toronto, Toronto, Ontario, Canada.
12
Burnaby Hospital, Fraser Health Authority, Burnaby, British Colombia, Canada.
13
Institut de Cardiologie de Montréal, Université de Montréal, Montréal, Québec, Canada.
14
Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.
15
Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada. Electronic address: cantorw@rogers.com.

Abstract

Rapid reperfusion of the infarct-related artery is the cornerstone of therapy for the management of acute ST-elevation myocardial infarction (STEMI). Canada's geography presents unique challenges for timely delivery of reperfusion therapy for STEMI patients. The Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology STEMI guideline was developed to provide advice regarding the optimal acute management of STEMI patients irrespective of where they are initially identified: in the field, at a non-percutaneous coronary intervention-capable centre or at a percutaneous coronary intervention-capable centre. We had also planned to evaluate and incorporate sex and gender considerations in the development of our recommendations. Unfortunately, inadequate enrollment of women in randomized trials, lack of publication of main outcomes stratified according to sex, and lack of inclusion of gender as a study variable in the available literature limited the feasibility of such an approach. The Grading Recommendations, Assessment, Development, and Evaluation system was used to develop specific evidence-based recommendations for the early identification of STEMI patients, practical aspects of patient transport, regional reperfusion decision-making, adjunctive prehospital interventions (oxygen, opioids, antiplatelet therapy), and procedural aspects of mechanical reperfusion (access site, thrombectomy, antithrombotic therapy, extent of revascularization). Emphasis is placed on integrating these recommendations as part of an organized regional network of STEMI care and the development of appropriate reperfusion and transportation pathways for any given region. It is anticipated that these guidelines will serve as a practical template to develop systems of care capable of providing optimal treatment for a wide range of STEMI patients.

PMID:
30760415
DOI:
10.1016/j.cjca.2018.11.031

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