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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.
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
"2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines". Circulation. Published online September 23, 2014 (25): 2354–2394. doi: 10.1161/cir.0000000000000133. PMID 25249586
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]
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 ]
In patients with UA/NSTEMI, the TIMI risk score is a prognostication scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making. [1] TIMI Score Calculation (1 point for each): Age ≥ 65 years; Known coronary artery disease (CAD) (stenosis ≥ 50%) ≥ 3 risk factors for CAD*
As early as the 1980s, the college partnered with the American Heart Association to develop the first clinical practice guidelines for cardiovascular practice. In the 1990s, the college used the guidelines to lay the groundwork for studies documenting discrepancies best and actual cardiovascular practices.
According to the ACC/AHA guidelines, intravenous digoxin (cardiac glycoside) can be used in atrial fibrillation (Afib) to assist heartbeats. [90] In multicenter randomised controlled trials, intravenous digoxin was shown to be effective in controlling the heart rate compared to a placebo. [91] [92]