Clinical impact of a cardiothoracic ultrasound protocol in patients with ST-segment elevation myocardial infarction: the focused assessment in STEMI (FASTEMI) protocol
Recommended Citation
Barcellos Amon A, Pinheiro Machado G, Heiden Telo G, Petersen Saadi M, Azeredo Azevedo WT, Martins A, Nassif M, Neves de Araújo G, Scolari FL, Donelli da Silveira A, Babar Basir M, Soliman-Aboumarie H, Vugman Wainstein M, and Vugman Wainstein R. Clinical impact of a cardiothoracic ultrasound protocol in patients with ST-segment elevation myocardial infarction: the focused assessment in STEMI (FASTEMI) protocol. Intern Emerg Med 2025.
Document Type
Article
Publication Date
11-26-2025
Publication Title
Intern Emerg Med
Keywords
Echocardiography; Lung ultrasound; Mortality; Myocardial infarction; Point-of-care ultrasound; Risk stratification
Abstract
ST-segment elevation myocardial infarction (STEMI) remains a condition with high morbidity despite advancements in treatment. Physical examination for heart failure and identification of mechanical complications can be inconsistent. Point-of-care ultrasound (POCUS) has proven valuable in acute cardiovascular care. We developed the Focused Assessment in STEMI (FASTEMI) protocol to enhance early evaluation, identify complications, and guide management. This single-center prospective cohort study included patients with presumed STEMI between June 2023 and June 2024. The FASTEMI protocol was performed upon admission and comprised lung ultrasound to assess congestion, and cardiac ultrasound to evaluate ventricular function, detect mechanical complications, measure left-ventricular outflow tract velocity-time integral, and assess the inferior vena cava. A total of 214 patients had a confirmed diagnosis of STEMI, whereas 17 were diagnosed with other conditions. FASTEMI altered diagnosis or management in 33 cases (14%) (CI 95% = 11.2 - 20.9). Identification of left ventricular (OR 1.26, 95% CI = 1.11-1.43; p < 0.001), right ventricular (OR 1.3, 95% CI = 1.04-1.75; p < 0.001), and biventricular dysfunction (OR 1.96, 95% CI 1.14-3.38; p < 0.001) were associated with in-hospital mortality. A normal FASTEMI exam had a 97% negative predictive value for mortality and did not delay door-to-balloon time. FASTEMI enhances early diagnosis, risk stratification, and management of STEMI. It enables rapid identification of complications, optimizes individualized treatment, and provides prognostic information without prolonging door-to-balloon time. Its feasibility supports its role as an adjunctive bedside tool.
PubMed ID
41291168
ePublication
ePub ahead of print
