GUEST COMMENTARY: Heart attack patients need the ER, not STEMI Regional Centers

Monday, December 3, 2012 | 3:36 p.m. CST

Extremely important to Missourians having the most serious heart attack, a STEMI (ST Elevation Myocardial Infarction), is the 2008 state law calling for Regional STEMI Centers, requiring “Patients who suffer a STEMI, as defined in section 190.100, shall be transported to a STEMI Center,” bypassing the local hospital and depriving you of the lifesaving and disability-reducing fibrinolysis (clotbuster) treatment available within 30 minutes at every ER. The purpose of the law is to deliver you to a large hospital with a cardiac catheterization laboratory (cath lab) for balloon coronary angioplasty.

A STEMI results from a blood clot obstructing a coronary (heart) artery nourishing heart muscle. Your surviving the attack and reducing disability from it depend  on how much of the affected muscle is saved by treatment. Nearly all involved muscle can be saved if blood flow is restored by reopening the artery before the end of two hours after symptoms began. That can be achieved in only a small percentage of cases by angioplasty. A study in one high-performance U.S. hospital showed that only 9 percent of patients treated received it during that period. In the Missouri program, with increased travel distances, reaching that frequency is unlikely. Therefore, the vast majority of STEMI patients in the Missouri program will be receiving angioplasty at a time when little if any heart muscle can be saved, with excessive deaths and disability.

By contrast, a huge national study showed that 39 percent of patients treated with fibrinolysis received it during the first 2 hours of symptoms. Another report stated that 56 percent of U.S. STEMI patients are treated with fibrinolysis in smaller hospitals without cath labs. Clotbuster treatment during the first 60 minutes of symptoms, the Golden Hour, cuts deaths in half.

A patient may be taken to a local hospital for emergency care before transport to a center, or for fibrinolysis if cath lab arrival time is excessive. Only patients picked up at the scene of illness by ambulance are included. Patients arriving at the local hospital by car are not to be transported.

Serious program consequences are increased deaths and disability and local hospital patronage loss, threatening solvency and physician availability. Costs will increase. Angioplasty is far more expensive than fibrinolysis, even including possible follow-up angiography.

How can you secure prompt STEMI treatment? First, learn the Early Warning Signs of Heart Attack and quickly respond by calling your doctor. If not immediately available, get to the nearest ER by the quickest means, usually the family automobile. If you seem severely ill or have no other transportation, call 911. At the ER, you have a right to an informed choice of treatment. A minority of patients, those at high risk, are best treated by angioplasty.

Finally, our legislators had no authority to mandate where your heart attack is to be treated and by what method. Judicial review is needed.

Glen O. Turner is a physician in Springfield and past president of the Missouri Heart Association. He is also a fellow on the council on clinical cardiology for the American Heart Association.

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