Doctor Khot, the Head of Regional Cardiovascular Medicine at the Cleveland Clinic, talks about STEMI protocol.
What is STEMI and what does it stand for?
KHOT: STEMI stands for ST elevation myocardial infarction. It is a very serious type of heart attack. It occurs in about three million people a year. And it occurs because one of the main arteries of the heart has a 100 percent blockage. Because of the 100 percent blockage, the heart muscle is dying. And it’s important that patients get emergency care to open up the artery as soon as possible.
What percentage of cardiac patients experience this severe type of heart attack?
KHOT: This is uncommon in terms of particularly patients showing up to the emergency department with chest pain. Most patients with chest pain don’t have this. But it is actually probably the most common type of presentation of serious type of heart attack. And so we do see it very often on an everyday basis.
Can you describe the traditional treatment for a STEMI patient?
KHOT: So, I think the treatment for the STEMI patient has changed over time. We used to give medications called thrombolytics. We’ve now changed to doing what’s called angioplasty and stenting. And then the biggest change, which was part of our protocol, was to move how we did the angioplasty and stenting procedure to doing it through the wrist as opposed to the groin. So, over the last 20 years, there have been changes in terms of how this heart attack is treated so that the artery can be opened as soon as possible and safely.
What is the primary goal of the protocol, and can you explain to our viewers why this is critically important?
KHOT: When patients present with ST elevation myocardial infarction, it’s an emergency. And so, it’s very important that the care team in the emergency department and in the Cath lab know exactly what needs to be done for the patient, no matter when they present or where they present. And so our protocol laid out very precisely exactly what should happen for the patient from the time they show up to how they’re treated with medications and how they’re transported to the Cath lab and then how the procedures are done.
Can you give us details about a recent study of the protocol and how was it conducted and over what period of time?
KHOT: So, we looked at data going all the way back to 2011. But the protocol was put in place in 2014. We wanted to see what impact this protocol had on patients who reside in lower socioeconomic neighborhoods. We know that those patients tend to be higher risk and have a higher risk of dying from this heart attack, but nobody knows what can be done to help these patients. And so what our protocol showed is that if you focus on eliminating what we call care variability to make sure that every patient receives high quality care every time, then those patients in those neighborhoods actually benefited the most. And we saw a significant improvement in how they received medications and how fast they were treated. And ultimately, that led to a 60 percent reduction in their chances of dying.
What did the most recent study of the protocol find? I think you’ve kind of touched on that. What are the implications of these findings?
KHOT: I think the implications are that the care delivery system, meaning the hospitals and emergency departments, can have a major impact in reducing disparities in care by making sure that every patient is treated the same way with this condition. And those patients who have traditionally had poorer outcomes with this condition can really benefit and have a much greater chance of surviving.
Can this protocol be implemented at other health care facilities, or does it require specialized equipment or training?
KHOT: There are no specialized equipment. This is the same type of equipment people use around the country and around the world. It really has to do with how that care is organized and that care must be organized in a very precise way so that every patient receives the same care. We’ve already received a number of inquiries about this protocol from around the country. And we think it’ll really benefit many other hospitals throughout the United States.
Is there anything we didn’t ask that you would want to make sure that people know?
KHOT: I think the biggest thing with COVID is to make sure that people understand that if they have serious chest pain or shortness of breath, they should seek emergency care. We’re seeing a lot of patients delay care because of concerns with COVID. And especially with this type of heart attack, it’s important to get to an emergency department as soon as possible so that they can be diagnosed and then treated properly and quickly.
Interview conducted by Ivanhoe Broadcast News.
END OF INTERVIEW
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