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ST-Elevation Myocardial Infarction

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Reperfusion At a PCI-Capable Hospital ÎÎPrimary PCI should be performed in patients with STEMI and ischemic symptoms of <12 hours' duration. (I-A) ÎÎPrimary PCI should be performed in patients with STEMI and ischemic symptoms of <12 hours' duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from FMC. (I-B) ÎÎPrimary PCI should be performed in patients with STEMI and cardiogenic shock or acute severe heart failure (HF), irrespective of time delay from MI onset. (I-B) ÎÎPrimary PCI is reasonable in patients with STEMI if there is clinical and/or ECG evidence of ongoing ischemia between 12 and 24 hours after symptom onset. (IIa-B) ÎÎPCI should NOT be performed in a noninfarct artery at the time of primary PCI in patients with STEMI who are hemodynamically stable. (III-B: Harm) Table 2. Primary PCI in STEMI CORa LOEa Ischemic symptoms <12 h I A Ischemic symptoms <12 h and contraindications to fibrinolytic therapy irrespective of time delay from FMC I B Cardiogenic shock or acute severe HF irrespective of time delay from MI onset I B IIa B III: Harm B Evidence of ongoing ischemia 12-24 h after symptom onset PCI of a noninfarct artery at the time of primary PCI in patients without hemodynamic compromise a COR, Class of Recommendation; LOE, Level of Evidence 3

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