Standards for the Management of acute ST-segment Elevation Myocardial Infarction (STEMI) in Québec (update of April 2021)

To improve the management of acute ST-segment elevation myocardial infarction (STEMI), INESSS published, in 2016, a provincial field evaluation and an evidence review on optimal modalities, which were used to develop standards of STEMI care for Québec. New Canadian clinical practice guidelines and an update of inter-hospital transfer directives by the Collège des médecins du Québec have subsequently been published.

INESSS has thus updated these provincial standards. They are presented according to five areas:

1. prehospital emergency services;
2. hospitals offering PCI;
3. hospitals that do not offer PCI;
4. networks: communication, structure and integration des services; and 
5. support of quality improvement.

There are now 40 standards in total: 17 new standards have been added, 14 have been revised, and 9 are unchanged. The changes notably address the maximum recommended time for direct ambulance transport of a patient in stable condition to a PCI hospital without medical accompaniment, interhospital transfers and the management of patients in cardiogenic shock. Some standards include quality indicators or targets for the purposes of performance evaluation and quality improvement.

Note: A summary of a rapid response update published in the COVID section is also available in English, which outlines the required adaptations to the provincial standards in the context of a COVID-19 pandemic.