LUMEN 2009: The World’s Premier STEMI Meeting: The Symposium on Optimal Treatments for Acute MI

LUMEN takes place February 26-28, 2009, at the Loews Hotel in Miami Beach, Florida. More information is available online at www.LumenAMI.com

Cath Lab Digest talks with meeting director Sameer Mehta, MD, FACC, and LUMEN’s four co-directors, each managing a crucial topic: Emergency Medicine, Door-to-Balloon Processes, Interventional Cardiology and Cardiovascular Nursing. Director, LUMEN: Sameer Mehta, MD, FACC Why have a meeting focusing solely on STEMI interventions? Primary percutaneous coronary intervention (PCI) has always occupied a special place within interventional cardiology. It is an outstanding indication of PCI and probably its finest. Each year, the field of primary PCI has evolved, with formulation of improved strategies, development of new techniques, publication of new data from clinical trials and advances in equipment. However, since 2005, with the advent of new American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for door-to-balloon (D2B) times for ST-elevation myocardial infarction (STEMI) interventions, this area of interventional cardiology has evolved into an entirely new specialty. Although it was always known that restoring flow to the myocardium with rapid recanalization of the infarct-related artery was vital, the new guidelines have forced a scientific, legal and quality mandate on interventional cardiologists and upon institutions that provide treatment to these patients. Suddenly, to achieve D2B times of Emergency Medicine: James W. Hoekstra, MD How is the ECG best handled with an incoming STEMI patient, both in process and procedure? The best, meaning most effective, method of utilizing the electrocardiogram (ECG) for STEMI is by obtaining it in the prehospital arena, by trained paramedics, prior to arrival in the ED. Transmission of the ECG to the receiving hospital allows activation of the catheterization lab prior to hospital arrival. This allows the shortest door-to-balloon times. For walk-in patients, utilization of the 12-lead ECG as a protocol-mandated screening tool in anyone who has symptoms suggestive of acute coronary syndrome (ACS) will shorten the time to ECG in all patients, and pick up STEMI in the highest percentage of patients with atypical presentations. The use of ECGs in triage and nurse or tech-obtained ECGs in all patients with suggesting symptoms of ischemia prior to physician evaluation has become the standard of care. How will LUMEN help attendees’ emergency departments to take on a strengthened role in STEMI care? LUMEN will educate ED physicians and cardiovasular care providers in the state-of-the-art diagnosis and treatment of STEMI. This includes not only pharmacotherapy and reperfusion techniques for STEMI, but also diagnostic techniques such as prehospital ECGs, novel ECG technologies, and system issues which enhance door-to-reperfusion therapy in patients with STEMI. Finally, quality assurance techniques will be demonstrated and discussed as ways to improve and maintain optimum treatment outcomes in STEMI. A very hands-on, experientially-based educational program allows care providers to see “what’s out there” and incorporate lessons for care into their own systems. Door-to-Balloon Processes: Brahmajee Nallamothu, MD, MPH, FACC Do all facilities face the same challenges in reducing door-to-balloon times? Yes and no. Some challenges faced by PCI hospitals are universal. For example, the need to promote early triage and ECG diagnosis of patients with STEMI, perhaps using streamlined protocols for chest pain evaluation. However, some challenges will be unique to that facility. Examples of these may be related to the geographic context — that is, rural versus urban challenges — as well as the availability of resources like on-site cardiac surgery or academic programs. The key is to understand that there is an accumulated body of knowledge on how some hospitals have achieved extraordinary door-to-balloon times under varying circumstances. Taking these “lessons,” learned from high-performing centers and then applying them in a personal way to each institution’s own challenges was the approach adopted by the D2B Alliance. What will be most useful at LUMEN for facilities still looking to reach that “at or below” 90-minute mark? At LUMEN, cath lab professionals will be able to interact with physician and nursing leaders that have been directly involved with large national efforts to organize STEMI systems of care across regions and in hospitals. This interaction will include not just formal lectures, but practical workshops on how to get these types of programs up and running despite all the barriers that hospitals are likely to face. My experience is that this type of individual interaction is invaluable in understanding how your own facility can overcome its own challenges to achieving this national standard. Interventional Cardiology: Samin Sharma, MD, FACC What challenges in STEMI cases confront interventionalists today? The most important issue on everyone's mind, which still remains challenging, is how to get a door-to-balloon time of Cardiovascular Nursing: Barbara T. Unger, RN, BS, FAACVPR What are some of the critical nursing issues in care of the STEMI patient? The Minneapolis Heart Institute program focus is on not only their own ED-to-PCI times, but also on an expanded outstate program. With this expansion comes further challenges to our door-to-balloon times. Meeting required D2B times can only be achieved with great attention to detail. The ability to track and identify any delays comes through immediate data awareness. With immediate awareness and immediate communication, issues are quickly identified and not allowed to further frustrate or potentially derail a start-up outstate hospital transferring to the tertiary center. In nursing, protocols will generate the standing orders and methods to achieve medication compliance. Nursing, working together, will initiate meds, and utilize a check and balance method along the continuum to assure 100% compliance. Education remains paramount to the success of any program. This education is necessary for physicians (primary and ED), nursing and EMS. These divisions must collaborate to develop the process. We will show methods of achieving this and also, recognize, as programs exist over the years, that RETRAINING will become necessary. Finally, what happens when this method is applied to other emergency conditions? We will have a demonstration of building upon the success of STEMI transfer networks to address conditions that occur in high-risk patients, i.e. cardiac arrest. What will LUMEN offer to cardiovascular healthcare professionals involved in treating these patients? We will discuss “real life” issues and methods to address barriers to achieving in-house D2B times, but also ways to achieve a transfer program working with our outstate emergency departments. The LUMEN conference will bring together nursing leaders in several successful programs. The purpose is to allow nursing and others to look at programs that they could possibly mirror or use as a jumping-off point to set up their own programs. The LUMEN conference will provide attendees with extensive understanding of the role of EMS, including video of “hot-loaded” patients. We will show methods to assist our EMS, both pre hospital and in transport, which are essential to achieving the mandated D2B time. Nursing coordination of this great collaboration is a must. LUMEN will show several successful programs and suggest methods to achieve similar success. Detailed information will be provided on developing feedback methods, educational conferences and of course, public awareness of programs.

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