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Acute Coronary Syndrome

The Acute Coronary Syndrome (ACS) programme is endeavouring to standardise 21st Century treatment of acute coronary syndromes (heart attacks) nationally to reduce mortality and morbidity from heart attack ( save up to 30 lives per year and reduce incidence of related strokes).

Acute coronary syndromes and how they are treated

Acute Coronary Syndromes (ACS) are heart attacks (or myocardial infarction) and unstable angina.

There are two types of heart attack, distinguished by the electrocardiogram (ECG) appearance:

  • ST elevation myocardial infarction (STEMI); and
  • Non ST elevation myocardial infarction (NSTEMI).

The STEMI are the major heart attacks caused by a blockage in the arteries supplying blood to the heart muscle.

STEMIs are diagnosed using 12 lead ECG machines. They are treated urgently by either use of a clot-busting drug (thrombolysis) or by insertion of a wire into the artery to open it using a balloon to allow the blood to flow to the heart muscle again. This is known as a primary percutaneous coronary intervention (PPCI), sometimes referred to as a primary angioplasty and can only be done in a hospital equipped with an emergency catheter laboratory.

NSTEMI heart attacks and unstable angina are initially treated medically and in the majority of cases are sent for an early investigation of the arteries to the heart (called an angiography) done in a hospital equipped with a catheter laboratory.

What the ACS Programme is doing?

The ACS programme is trying to improve and standardise the care of ACS patients by ensuring that:

  • Ambulances are equipped and paramedics trained to recognise a major heart attack (STEMI) and to transport these patients to the best place (a primary PCI centre hospital if within transport time limits) for appropriate care. If a STEMI patient cannot be transferred to a PPCI centre within 90 minutes then transfer to the nearest emergency department to allow thrombolysis. This is known as the Optimal Reperfusion Service (ORS) protocol.
  • Primary PCI centre hospitals are designated based on having available catheter laboratories plus a requisite number of cardiologists that are trained in PPCI. There are 5 designated 24/7 PPCI centres and one 9-5, Monday to Friday PPCI centre.
  • Other non PPCI centre hospitals are clear on how best to treat all ACS patients and arrange timely transfer of ACS patients that need further investigation to PPCI centre hospitals.
  • Cardiac Rehabilitation programmes are established in all areas and that every ACS patient has the opportunity to be part of a Cardiac Rehabilitation programme.
  • The public can recognise the possible signs of a heart attack and to contact the emergency services (ph 999 or 112) immediately.
  • First response to collapse - by ambulance, uniformed co-responders and community responders - is improved throughout Ireland.
  • Systems are in place to measure the performance of the ACS programme.

Clinical Strategy and Programmes Division