Heart attacks are dangerous, but STEMI heart attacks can become deadly in a very short time. In Ottawa, a massive collaborative project is saving time and lives when every minute counts.

[ News Release 2009-30 ]

You're short of breath and there is a pain starting in your chest and shooting down your arm and side. You call 911, and when the paramedics arrive and load you into the ambulance they hook you up to electrocardiogram machine to get a quick look at your heart rhythm. They confirm that you are having a heart attack, and they mention a funny medical word: STEMI.

They've been heading to your local Ottawa hospital, but all of a sudden they change direction and take you to the Ottawa Heart Institute. The paramedic in the back pulls out a special cell phone and calls ahead, describing your case on a dedicated STEMI heart attack phone line to a waiting receptionist who alerts the angioplasty team.

When you arrive at the Heart Institute, the paramedics know to go directly to the STEMI room where the team is assembled. In a few more minutes you have been given stabilizing drugs and are being prepped for surgery. In less than 90 minutes, you have had angioplasty surgery to reopen and inflate the artery. The lasting damage and chance of death are minimal, and in a few days you will go home.

This entire sequence of events is the brainchild of Dr. Michel Le May, a cardiologist and director of the Coronary Care Unit Research Group at the Ottawa Heart Institute.

STEMI events, or ST-segment elevation myocardial infarction, were one of the most deadly forms of heart attack, where time to treatment must be measured in minutes. Then in the 1980s a new group of clot-busting pharmaceuticals were introduced to clear blocked arteries. However, these pharmaceuticals were not without side effects, not the least of which included bleeding in the brain.

So, doctors started opening the clogged artery by inserting a balloon, a process commonly called angioplasty, which is much more effective for overall health. But, threading a catheter up the groin and into the heart to open an artery requires a high degree of specialization and expertise, impossible to have at every hospital. Add to this the time constraint that treatment should be done within 90 minutes.

In Ottawa, the Ottawa Heart Institute is the only hospital that performs angioplasties, but getting STEMI patients there took too long. After doing several studies into what would work best for patient health, Le May forged a new way of handling heart attacks that empowered paramedics to read electrocardiograms and decide where a patient should be taken, something that previously could only be done by ER physicians.

Since July 2004, almost one STEMI heart attack patient a day has gone directly to the Ottawa Heart Institute, usually receiving care in less than the prescribed 90 minutes. Because of Le May's research, their risk of death has been reduced by half and patients are even able to leave the hospital faster.

"It's amazing. There's no going back," said Le May. "In a very short time we go from a completely blocked artery to completely open artery, and the patient feels better. Our mortality rate continues to be down by 50% and we've treated more than 1,500 patients, so we know that our results continue to prove this is the best strategy."