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

Training Tutorial 1.4

Treatment of STEMI

STEMI treatment may involve angioplasty (PCI) or the use of “clot buster” drugs (thrombolytics). Which one is better? It depends on the patient and situation. Studies have shown that PCI is somewhat better than thrombolytics (all other things being equal) unless there is a delay in getting that patient to the PCI lab. If the delay is too great, the benefits of PCI over thrombolytics can be lost. This brings us to a very important point: In treating STEMI, the focus should usually be on time to reperfusion rather than the exact reperfusion strategy selected! A key role of project UPSTART is to streamline the routine preparation and management of STEMI patients so the physician has more time to carefully answer this exact question!

So, just how do we improve treatment times in STEMI? One would think we should have all the solutions, since so much research has been done in this area. However, it’s not that simple! People who study quality improvement understand the key to improvement is often not new knowledge, but better strategies for applying existing knowledge. We have designed a standardized process based on the best available knowledge, and you have customized it in the best available manner to fit your institution. No sense in reinventing the wheel!


  • During a heart attack, Time = Muscle!
  • The more recent the STEMI - the more this applies.
  • Early recognition and early reperfusion are critical.
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