Despite the increased recognition of the role of the ECG in the diagnosis of acute MI in the days since Dr. Herrick, many decades passed until advances in treatment caught up. Unless the patient underwent prompt coronary bypass surgery, most acute therapy was directed at pain relief, rest and arrhythmia treatment. The options for definitive treatment were limited until fibrinolytic therapy for acute MI came along. The advent of fibrinolytics, followed by the adoption of percutaneous coronary intervention (PCI), ushered in a new age in which speed and communication became paramount in the care of the STEMI patient. As the evidence mounted that “time is muscle” and swift intervention was required to restore perfusion and reduce ischemic injury, hospitals developed an alert system that notified key personnel to the presence of a patient diagnosed with STEMI or its equivalent. Whether it is called “STEMI Alert,” “Code STEMI” or something else, this rapid notification system remains the cornerstone in the process of care for STEMI patients to this day.
Caution #1: The classic STEMI ECG is easy to interpret. Master the fine points of ECG interpretation to catch the subtle or uncommon findings.
Caution #2: Beware the faulty or misleading computer-generated ECG interpretation. It is only as good as the person who programmed it.
Caution #3: If the first ECG is not diagnostic, do another ECG if the clinical picture is concerning or the patient gets worse.
Caution #4: Check an old ECG, as subtle ischemic changes may be new.
Code STEMI remains one of the most important and electrifying patient interactions in acute care medicine. “Time is muscle!” Your patients know this, their attorneys know this, the hospital knows this, and the folks looking at quality and writing the reimbursement checks know this. A missed MI is still high on the list in terms of average dollars spent on a med-mal case. Delays in the diagnosis and treatment of acute MI continue to be a major threat to patient safety. Be sure that you and everyone on your ED Department Team recognize that Code STEMI is a “seconds-to-minutes” emergency requiring your immediate attention and intervention in order to achieve the best outcome.