International Recognition for the STEMI Heart Attack Program

March 2014

Michel Le May, MD
Michel Le May, MD

When you hear “Code STEMI” announced over the loudspeakers at the University of Ottawa Heart Institute, you can be sure of two things: Someone in the Ottawa region is having a serious heart attack, and he or she may well be in the best place in the world for that to happen.

A STEMI (ST-elevation myocardial infarction) is the most dangerous type of heart attack. It means that a coronary artery is completely blocked and part of the heart is being starved of oxygen. The standard of care for these heart attacks is to get the blocked artery open and blood flowing again as soon as possible. Interventional cardiologist Michel Le May, MD, was honoured in January of this year with the Lumen Global Achievement Award for the pioneering work of Dr. Le May and the Heart Institute’s STEMI team to get that blood flowing more quickly.

The Institute’s Regional STEMI Program was the first in Canada in 2004 and one of the first in the world. A landmark paper published in the New England Journal of Medicine in 2008 detailed the practical implementation of the Ottawa program and showed that it cut STEMI heart attack deaths by 50%.

“Within the STEMI program, for every 100 patients that we treat, we save an additional five lives beyond those that we were saving before,” said Dr. Le May. “That has been a steady and sustained performance since the program was launched.” Now encompassing the entire Eastern Ontario region (see map), the STEMI program will celebrate its 10th anniversary this summer. Over those 10 years, the program has been directly responsible for saving an additional 200 to 250 lives.

In establishing the program, Dr. Le May identified the evidence that rapid revascularization for acute, severe heart attack is the best possible care for patients and then sought out the best way to deliver that care. STEMI care is all about speed—getting the patient to the catheterization lab as fast as possible to get the blocked artery open. This is usually done with angioplasty, in which a balloon is expanded in the artery and a stent is implanted to hold the blood vessel open.

Map of STEMI protocol within the Ottawa region
The Heart Institute’s STEMI heart attack program covers the entire referral region, which encompasses 16 hospitals. Those that are centrally located transport STEMI patients directly to the Heart Institute for interventional treatment. More distant, rural sites administer clot-busting drugs prior to helicopter transport. The direct transport area has recently been expanded to include the city of Renfrew.

The key to the program’s remarkable success has been to line up the pieces of the care delivery system to work in a seamless flow. A critical piece on the front line was to work with paramedics and the ambulance service to have the paramedics trained to read electrocardiograms (ECGs). Now STEMIs can be identified in the field and routed directly to the Heart Institute, saving precious time. Dr. Le May also worked internally with doctors and nurses to implement a 24/7 response system. Teams, consisting of cardiologists, nurses and technicians (with surgeons on call), are on standby all day every day to leap into action for any “Code STEMI” call.

“This was a whole new way of delivering care,” said Rob Beanlands, MD, Chief of Cardiology at the Heart Institute. “It really was transformative. And it’s a great example of how the Heart Institute is able to take on a problem and enable the system to change to improve patient care. Nobody wants to have a heart attack,” he continued. “But if you’re going to have one, this is the best place in the world to do it.”

Following the New England Journal article, the Heart Institute’s program became a model emulated in other cities in Canada and across the globe. The Lumen Global Achievement Award was presented to Dr. Le  May last January in Bangkok, Thailand, in recognition of the achievements and wide-ranging influence of the Ottawa STEMI program. Lumen Global is an international organization of leading acute heart attack specialists focused on improving STEMI care worldwide. Its award announcement stated that Dr. Le May’s work “has had far-reaching impact on the optimization of other STEMI networks.”

“Many people in the Ottawa region owe their lives to the Heart Institute’s STEMI program,” Dr. Beanlands concluded. “The Lumen Award recognizes that it’s not just Ottawa but people around the world that can thank Dr. Le May and the STEMI team. They have set a very high standard for what other cities can achieve.”