As I’m a newly licensed nurse in Canada, while going through these resources helped me

to acquire knowledge regarding Ontario’s STEMI care protocols and recommendations. I hope

this would help me to apply these practices in my new position as an RPN. I’m really excited to

go and familiarize with the STEMI protocols and reperfusion algorithm which are in place in the

hospital that I’m going to join next week

Best Practice Recommendations

Upon reflecting on these resources, I acknowledged the fact that CCN (Cardiac Care

Network of Ontario) is committed to sharing knowledge and information that fosters leading

practices and helps to establish benchmarks and standards for optimal care. 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

center or at a percutaneous coronary intervention-capable center. (CorHealth Ontario, 2013)

Algorithms

A significant aspect to be noted is that timely reperfusion after STEMI has been shown to

reduce mortality (Rollando, 2012) and morbidity (e.g. readmission for heart failure or AMI)

(Cantor 2009, Lambert 2010). The American College of Cardiology/American Heart Association

(ACC/AHA) guidelines recommend that STEMI patients treated by primary PCI presenting to a

PCI capable hospital have a door-to-balloon (D2B) time of less than 90 minutes and patients

treated with fibrinolysis therapy have a door-to-needle (D2N) time of less than 30 minutes;

patients presenting to a non-PCI capable hospital should have a D2B time of less than 120

minutes (ACC/AHA 2011) Practice Treatment Patients with ischemic chest pain of onset within

the past 12 hours and ECG abnormalities consistent with an acute STEMI should be considered
for reperfusion strategy either by primary PCI or fibrinolysis Therapy. Primary PCI is the

preferred reperfusion strategy with improved outcomes compared to fibrinolysis therapy when

performed by experienced operators and teams within the recommended D2B time. (CorHealth

Ontario, 2013)

Stakeholders

In 2011 CCN established the STEMI Network Working Group, comprised of

cardiologists, interventional cardiologists, emergency department physicians, base hospital

medical directors, paramedic chiefs, paramedics, and administrators play a vital role in early

identification and in timely access to reperfusion therapy for STEMI clients. (CorHealth Ontario,

2020).

References

CorHealth Ontario. (2020, March). ST Elevation Myocardial Infarction (STEMI)

https://www.corhealthontario.ca/resources-for-healthcare-planners-&-providers/stemi/stemi-

resources

CorHealth Ontario. (2013, June) Recommendations for Best-Practice STEMI Management in

Ontario https://www.corhealthontario.ca/Recommendations-for-Best-Practice-STEMI-

Management-in-Ontario-(6).pdf
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