Project UPSTART: the Use of Procedural Standardization to Reduce Recognition to Repferfusion (R2R) Time in ST-Elevation Myocardial Infarction (STEMI)

Training Tutorial 1.3

The Theory Behind the “Need for Speed”

Project UPSTART was designed as a program to help detect and treat STEMI faster. This is extremely important: the longer a coronary artery remains blocked (as occurs during a heart attack) the greater the amount of cardiac muscle that is damaged or destroyed.

In STEMI, is a treatment time of 45 minutes really better than 90 minutes? What about 45 vs. 60, or 40 vs. 50?

In most cases, the answer is YES, YES and YES! Time = Muscle!

The above graph clearly shows the curve of time vs. potential cardiac muscle salvage. Once an artery is blocked, cell death starts immediately and most damage is done in the first 2-3 hours. Therefore, early treatment can have a major payoff. Once an infarct is even several hours old, much of the damage is permanent. That is why early recognition is so important. No recognition = No progress to reperfusion.

This leaves little room for error or indecision. Once we lose time we cannot get it back!

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