Beginning in 2003, collaboration between cardiologists and the emergency department at Saint Louis University Hospital has focused on significantly improving care for patients with ST-segment-elevation myocardial infarction. This past year, we earned American Heart Association Gold distinction indicating exceptional compliance with guideline-based care for these patients (see appendix 3). The ability to achieve compliance with the 90-minute door-to-balloon time marker is one of the most crucial and difficult to achieve. This involves the rapid assessment and diagnosis of patients within the emergency department and then immediate transfer to the catheterization lab on a 24/7 basis so that a balloon can be expanded in the occluded artery within 90 minutes of a patient’s arrival at the facility. As shown in the graph, there has been a significant decrease in door-to-balloon times every year during this program (now achieving high levels of compliance).

• American Heart Association "Triple Performance Achievement" Distinction recognizing excellence in providing proven life-saving therapies to patients in a consistent and timely manner.
• Focus on immediate assessment and treatment for patients with heart attacks utilizing rapid delivery of balloon angioplasty to restore blood flow to the heart and to minimize damage.

Patients are often diagnosed with an atrial septal defect (ASD) or patent foramen ovale (PFO) upon undergoing trans-esophogeal echocardiographic evaluation following the occurrence of a stroke or stroke-like symptoms. Within the catheterization lab, we are able to provide definitive treatment to prevent recurrent strokes in these patients by implanting a closure device to rid the patient of their ASD or PFO. 15 such patients were successfully treated in the last 6 months of 2008 – all undergoing placement of a closure device under moderate sedation with intra-cardiac echo guidance and being discharged the following day.

Disorders of cardiac rhythm are extremely common in the United States, with 2 million people estimated to have atrial fibrillation. More life threatening rhythm disturbances also remain common, but fortunately can be prevented in many patients with advanced cardiovascular disease by utilizing an implanted defibrillator. Our cardiac rhythm program combines the expertise of specialty trained electrophysiologists with a state of the art electrophysiologic laboratory to offer all patients with heart rhythm disorders cutting edge diagnostic and treatment options.

Components:

• Biventricular pacing / defibrillator placement
• Arrhythmia ablation program:
• Ventricular tachycardia
• Re-entry tachycardia’s
• Atrial Flutter
• Atrial Fibrillation with Pulmonary Vein Isolation Procedure

Advanced Heart Failure Program:

• Offers evaluation and state-of-the art management for patients with heart failure
• Outpatient program aimed at maximizing the proven therapies in an individualized treatment regimen supplemented by appropriate use of implantable defibrillators and biventricular pacing

Coronary artery disease accounts for 1 out of every 5 deaths in the United States. At SLU, patients with coronary artery disease are managed in an integrative system that brings excellence in cardiovascular imaging, stress testing, cardiac catheterization with coronary stenting, and a comprehensive medical treatment program together. This program focuses on accurate diagnosis of coronary artery disease utilized advanced imaging and stress testing modalities. Furthermore, a specific patient focused treatment plan is then created aimed at improving the patient’s symptoms as well as reducing the subsequent risk for heart attack and coronary disease progression.

Components of Program:

• 64 Slice PET – CTA scanner offering noninvasive evaluation of a patient’s coronary arteries.
• LiveWell program at University Club Towers aimed at helping people avoid developing coronary artery disease.
• Echocardiographic and nuclear imaging stress testing laboratories.
• Inpatient and Outpatient cardiac catheterization laboratories.
• Cardiac Rehabilitation program for patients with coronary heart disease aimed to help them avoid progression of their disease.