Organizational and Economic Issues in the Management of Patients with Acute ST-segment Elevation Myocardial Infarction (STEMI)

In Quebec, it is estimated that 4800 patients are hospitalized each year for acute myocardial infarction with ST-segment elevation (STEMI). The immediate cause of this serious condition is the occlusion of a coronary artery by a thrombus that must be urgently cleared to minimize irreversible damage to the cardiac muscle. There are two treatments that can be used to reopen the occluded artery, fi brinolysis and primary percutaneous coronary intervention (PPCI). Both treatments are recommended in clinical practice guidelines of different countries. According to these guidelines and available evidence, it cannot be affi rmed that one of these methods of reperfusion is superior to the other for all patients in all clinical situations, at all times of the day. In this context, the best treatment for a particular patient will be that which is clinically appropriate and administered in a timely fashion, that is, within recommended delays. Such management is dependant on optimal organization and delivery of care and services.