Prise en charge des STEMI

Objectives

Standardise the management of ST-segment elevation myocardial infarction (STEMI) in Luxembourg through a nationally coherent, time-critical pathway aligned with the 2017 European Society of Cardiology guidelines, which are already applied in practice and support consistency with cross-border care.[1]The framework aims to ensure that every hospital maintains a STEMI protocol based on current Scientific Council recommendations.[2]

• Promote rapid recognition and escalation of suspected STEMI by directing patients and clinicians to contact the 112 emergency number, enabling pre-hospital emergency medical service involvement.[2]
• Obtain an electrocardiogram promptly, with testing in general practice when the patient presents there first and, otherwise, within 10 minutes of arrival at an emergency department.[2]
• Support clinically safe initial treatment by avoiding routine oxygen administration in patients without hypoxaemia, avoiding nitrate derivatives, and limiting injected aspirin to 250 mg.[2]
• Reduce inappropriate pre-admission treatment where the diagnosis is uncertain, including doubtful electrocardiograms, paced rhythms, or complete left bundle branch block.[1]
• Maintain care protocols as current evidence develops and ensure that new doctors receive the relevant pathway information.[1]

Implementation

Deliver STEMI care through coordinated action by community doctors, emergency services, the emergency medical service, hospitals, the National Institute of Cardiovascular and Cardiac Surgery, and the on-call interventional cardiology service.[2]The operational model links early assessment and emergency transport with specialist telephone consultation and, where appropriate, transfer for catheterisation-laboratory treatment.[1]

• Initiate pre-hospital management through 112 when STEMI is suspected, using the emergency medical service as the route into the acute-care pathway.[2]
• Perform a general-practice electrocardiogram for patients initially attending a practice, or obtain the test within 10 minutes of emergency-department arrival for those not first seen in general practice.[2]
• Withhold routine aspirin, heparin and ticagrelor before admission to the National Institute of Cardiovascular and Cardiac Surgery when the electrocardiographic diagnosis is uncertain, including in paced rhythm or complete left bundle branch block.[1]
• Discuss uncertain cases by telephone with the on-call interventional cardiologist before confirming medicines and definitive transfer to the catheterisation laboratory.[1]
• Circulate the direct telephone number of the on-call coronary angiography doctor in every emergency department to facilitate rapid specialist contact.[1]
• Update local protocols regularly and disseminate them to newly appointed doctors, supporting consistent implementation of the required pathway.[1]
• Document care-delivery time intervals across the pathway so that participants can analyse performance data and improve future patient management.[1]

Governance is supported by a Scientific Council-convened working group comprising representatives of cardiology, emergency medicine, general practice, hospitals, the emergency medical service, methodology and health administration.[3]Beyond time-interval documentation, the available material does not specify further indicators, reporting arrangements, evaluation methods, formal accountability mechanisms, budgets or financing arrangements.[2][1][3]

Monitoring & Evaluation

Monitoring centres on documenting the time intervals across the ST-segment elevation myocardial infarction care pathway, enabling analysis of service delivery and informing subsequent improvements in patient management.[1]

• Document care-delivery intervals for all participants in the pathway to support consistent analysis of timeliness.[1]
• Update clinical protocols regularly and distribute them to newly appointed doctors, supporting continued alignment with current evidence and pathway requirements.[1]
• Maintain hospital-specific ST-segment elevation myocardial infarction management protocols based on current Scientific Council recommendations, as required nationally.[2]
• Clarify that the available text does not specify defined performance indicators, reporting intervals, data governance arrangements, surveillance processes, audit methods, public reporting, or formal sanctions and accountability procedures.[1]

Costing & Financing

No budget, cost estimate, financing mechanism, funding source, resource-mobilisation plan, funding gap, economic evaluation, or economic assumption is specified.[2][1][3]

• Require hospitals to maintain and update ST-segment elevation myocardial infarction protocols, but do not quantify the staff, equipment, training, data-collection, or dissemination resources needed.[2][1]
• Involve emergency services, hospitals, community doctors, the National Institute of Cardiovascular and Cardiac Surgery, and on-call interventional cardiology services in delivery, but do not allocate costs or identify responsible funding bodies.[2][3]