This guideline covers care and treatment of people aged 18 and over with a type of heart attack known as spontaneous onset of myocardial infarction with ST-segment elevation (STEMI). It aims to ensure that adults with STEMI are assessed and treated as soon as possible to minimise the damage to their heart, and to help commissioners and healthcare professionals configure services so that people with STEMI can have the best outcomes.
ST-segment-elevation myocardial infarction (STEMI) occurs when a coronary artery becomes blocked by a blood clot, causing the heart muscle supplied by the artery to die. It belongs to a group of heart conditions known as acute coronary syndromes.
The incidence of STEMI has been declining over the past 20 years. It varies between regions and averages around 500 hospitalised episodes per million people each year in the UK. The London Ambulance Service attended 9,657 cardiac arrests in 2011–12 for a population of around 8.2 million people (1,177 per million people). Most of these will have been attributed to acute coronary syndromes, so the overall population prevalence of STEMI is likely to be in the region of 750–1,250 per million people.
Over the past 30 years, in-hospital mortality after acute coronary syndromes has fallen from around 20% to nearer 5%. This has been attributed to various factors, including improved drug therapy and speed of access to effective treatments.
... the overall population prevalence of STEMI is likely to be in the region of 750–1,250 per million people.
Nearly half of potentially salvageable myocardium is lost within 1 hour of the coronary artery being occluded, and two-thirds are lost within 3 hours. Apart from resuscitation from any cardiac arrest, the highest priority in managing STEMI is to restore an adequate coronary blood flow as quickly as possible. In the 1980s and 1990s, the best way to restore flow was to administer a fibrinolytic drug.
You can read the guideline on NICE's website.