Treatment
Reperfusion at a Non–PCI-Capable Hospital
Fibrinolytic Therapy When There Is An Anticipated Delay To
Performing Primary PCI Within 120 Minutes Of FMC (Table 4)
ÎÎIn the absence of contraindications, fibrinolytic therapy should be
given to patients with STEMI and onset of ischemic symptoms within
the previous 12 hours when it is anticipated that primary PCI cannot
be performed within 120 minutes of FMC. (I-A)
ÎÎIn the absence of contraindications and when PCI is not available,
fibrinolytic therapy is reasonable for patients with STEMI if there
is clinical and/or ECG evidence of ongoing ischemia within 12-24
hours of symptom onset and a large area of myocardium at risk or
hemodynamic instability. (IIa-C)
ÎÎFibrinolytic therapy should NOT be administered to patients with ST
depression except when a true posterior (inferobasal) MI is suspected
or when associated with ST elevation in lead aVR. (III-B: Harm)
Table 4. Indications for Fibrinolytic Therapy When There Is a
> 120-Minute Delay From FMC to Primary PCI
COR
Ischemic symptoms <12 h
Evidence of ongoing ischemia 12-24 h after symptom onset and
a large area of myocardium at risk or hemodynamic instability
ST depression, except if true posterior (inferobasal) MI is
suspected or when associated with ST elevation in lead aVR
8
LOE
I
A
IIa
C
III: Harm
B
