ACC GUIDELINES Bundle

ST-Elevation Myocardial Infarction (STEMI) (ACCF Bundle)

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Treatment ÎÎPCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators. (I-A) ÎÎEMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI, with an ideal FMC-to-device time system goal of ≤90 minutes.a (I-B) ÎÎImmediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non–PCI-capable hospital, with a FMC-to-device time system goal of ≤120 minutes.a (I-B) ÎÎIn the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non–PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays. (I-B) ÎÎWhen fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be administered within 30 minutes of hospital arrival.a (I-B) ÎÎReperfusion therapy is reasonable for patients with STEMI and symptom onset within the prior 12-24 hours who have clinical and/or ECG evidence of ongoing ischemia. Primary PCI is the preferred strategy in this population. (IIa-B) Evaluation and Management of Patients With STEMI and Out-of Hospital Cardiac Arrest ÎÎTherapeutic hypothermia should be started as soon as possible in comatose patients with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), including patients who undergo primary PCI. (I-B) ÎÎImmediate angiography and PCI when indicated should be performed in resuscitated out-of-hospital cardiac arrest patients whose initial ECG shows STEMI. (I-B) a The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. 1

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