STEMIcathAID vs IVUSAID

STEMIcathAID is a patient recognition, response, and record-keeping system designed to improve outcomes through adherence the American Heart Association’s Mission:Lifeline STEMI guidelines. Early restoration of blood flow to occluded coronary vessels has been shown to significantly improve outcomes for high-risk STEMI patients. STEMIcathAID aims to improve these clinical outcomes by optimizing their treatment following many of the recommendations of the AHA by reducing the time to STEMI recognition, lead acquisition, STEMI identification, notification of the catheterization lab, and reperfusion. There are multiple personnel and steps involved in caring for these high-risk patients. STEMIcathAID takes an algorithmic approach which will enhance the coordination and communication tasks essential to rapid assessment and easy transfer of STEMI patients from the field or outside facility. It will also provide protocols for the EMS or outside hospital provider to identify patients in cardiogenic shock even before their arrival in the catheterization lab. The application will integrate live GPS tracking of the patients alongside the time the alarm was raised prompting the sense of urgency in transferring the patient. Incorporating images, videos, illustrations, and live GPS tracking of the EMS, the design will be subdivided into three main sections: 1. EKG Upload by outside facility or EMS 2. Assessment of Cardiogenic Shock 3. STEMI patient transfer pathway When a medical provider, in the field, other hospital, or outpatient office, suspects STEMI, the provider uploads the EKG by taking a picture of it with their phone. Once the EKG is uploaded, the on-call attending at the PCI-capable facility receives a notification from the application. If the attending believes the patient is experiencing a real STEMI, the pathway is activated. Upon activation, the approximately 10-12 people involved in taking care of the patient are notified so they can begin preparations. Adhering to HIPAA compliance, all users log into the encrypted application and begin to collaborate such aspects as patient vitals, shock information, and emergency vehicle current location and estimated arrival time to the cath lab. Through the optimized communication and collaboration of multiple key players in the STEMI pathway, these time-critical, vulnerable patients can begin treatment promptly.

The IVUSAID App is a free educational mobile application which has been developed to teach medical professionals how to use intravascular ultrasound (IVUS) for PCI guidance based on the current guidelines using our extensive experience and large database of complex coronary cases. Despite the growing body of evidence for clinical benefits of IVUS-guided PCI, IVUS remains underutilized in much of the world including the United States. Challenges in image interpretation and education are among the barriers to widespread adoption of IVUS in everyday clinical practice. Mount Sinai Heart is a global leader within the field of interventional cardiology as well as mobile apps development. The myriad of cases and pathology which are seen in The Mount Sinai Cardiac Catheterization Laboratory make it the perfect center to educate medical professionals within this field. The Key Concepts section of IVUSAID describes principles of IVUS, image acquisition, and concepts of ultrasound behavior in various tissues. The Image Interpretation section of the app has dozens of representative cross-sectional images, videos, and descriptions of plaque types, stent apposition and expansion, artifacts, and more. A short video for each type of lesion or artifact and post-stent findings, in addition to an annotated representative cross section aims to overcome a major limitation of any article or book on IVUS which present a static image, since the actual IVUS pullback is dynamic. Twenty-one complex coronary cases demonstrate IVUS guidance in a variety of patient presentations and lesions including ACS, LM bifurcation, severely calcified lesions and calcified nodules, spontaneous coronary artery dissection, and malapposed stents as well as how IVUS was used to inform treatment decisions. An extensive quiz section helps deliver educational content in a more interactive format where answers are accompanied by detailed explanations and references. We hope that IVUSAID will help techs, fellows, and early-career physicians incorporate IVUS in their daily practice for stent sizing, post-stent optimization, and identification of appropriate treatment strategies.