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Door-to-balloon is a time measurement in emergency cardiac care (ECC), specifically in the treatment of ST segment elevation myocardial infarction (or STEMI). The interval starts with the patient's arrival in the emergency department, and ends when a catheter guidewire crosses the culprit lesion in the cardiac cath lab.
At least 10% of patients with STEMI do not develop myocardial necrosis (as evidenced by a rise in cardiac markers) and subsequent Q waves on EKG after reperfusion therapy. Such a successful restoration of flow to the infarct-related artery during an acute myocardial infarction is known as "aborting" the myocardial infarction.
Acute coronary syndrome is subdivided in three scenarios depending primarily on the presence of electrocardiogram (ECG) changes and blood test results (a change in cardiac biomarkers such as troponin levels): [4] ST elevation myocardial infarction (STEMI), non-ST elevation myocardial infarction (NSTEMI), or unstable angina. [5]
STEMI and primary PCI ACC/AHA/SCAI 2009 Joint STEMI/PCI Focused Update Class I-B, IIa-B UA/NSTEMI ACC/AHA 2007 guidelines for UA/NSTEMI patients Class I-B, IIa-B NSTE-ACS patients ACCP 2008 clinical practice guidelines for patients with NSTE-ACS Grade 1A, 2B PCI ACCP 2008 clinical practice guidelines for patients with NSTE-ACS Grade 1B
Emergency bypass surgery for the treatment of an acute myocardial infarction (MI) is less common than PCI or thrombolysis. From 1995 to 2004, the percentage of people with cardiogenic shock treated with primary PCI rose from 27.4% to 54.4%, while the increase in coronary artery bypass graft surgery (CABG) was only from 2.1% to 3.2%. [34]
Diagnosis is clear-cut if ECGs show elevation of the "ST segment", which in the context of severe typical chest pain is strongly indicative of an acute myocardial infarction (MI); this is termed a STEMI (ST-elevation MI) and is treated as an emergency with either urgent coronary angiography and percutaneous coronary intervention (angioplasty ...
In 2003, the AHA and the American Stroke Association created the Get With the Guidelines (GWTG)-Stroke program. [79] It is a voluntary registry that hospitals can use to receive the latest scientific treatment guidelines. [80] The program also collects data on patient characteristics, hospital adherence to guidelines, and patient outcomes. [79]
If blood flow through the coronary arteries is stopped completely, cardiac muscle cells may die, known as a myocardial infarction, or heart attack. [9] Coronary artery disease (CAD) is the most common cause of coronary ischemia. [7] Coronary ischemia and coronary artery disease are contributors to the development of heart failure over time. [10]