Treatment
Table 10. Indications for PCI of an Infarct Artery in Patients
Who Were Managed With Fibrinolytic Therapy or
Who Did Not Receive Reperfusion Therapy
COR
LOE
Cardiogenic shock or acute severe HF
I
B
Intermediate-or high-risk findings on predischarge noninvasive
ischemia testing
I
C
Spontaneous or easily provoked myocardial ischemia
I
C
Patients with evidence of failed reperfusion or reocclusion after
fibrinolytic therapy (as soon as possible)
IIa
B
Stablea patients after successful fibrinolysis, ideally between
3 and 24 h
IIa
B
IIb
B
III: No Benefit
B
Stablea patients >24 h after successful fibrinolysis
Delayed PCI of a totally occluded infarct artery >24 h after
STEMI in stable patients
a
Although individual circumstances will vary, clinical stability is defined by the absence of low
output, hypotension, persistent tachycardia, apparent shock, high-grade ventricular or symptomatic
supraventricular tachyarrhythmias, and spontaneous recurrent ischemia.
PCI of a Noninfarct Artery Before Hospital Discharge
ÎÎPCI is indicated in a noninfarct artery at a time separate from primary
PCI in patients who have spontaneous symptoms of myocardial
ischemia. (I-C)
ÎÎPCI is reasonable in a noninfarct artery at a time separate from
primary PCI in patients with intermediate- or high-risk findings on
noninvasive testing. (IIa-B)
Adjunctive Antithrombotic Therapy to Support Delayed PCI After
Fibrinolytic Therapy (Table 11)
Antiplatelet Therapy
ÎÎAfter PCI, aspirin should be continued indefinitely. (I-A)
ÎÎClopidogrel should be provided as follows:
• A 300 mg loading dose should be given before or at the time of PCI to patients
who did not receive a previous loading dose and who are undergoing PCI within
24 hours of receiving fibrinolytic therapy (I-C)
• A 600 mg loading dose should be given before or at the time of PCI to patients
who did not receive a previous loading dose and who are undergoing PCI more
than 24 hours after receiving fibrinolytic therapy (I-C) and
• A dose of 75 mg daily should be given after PCI. (I-C)
ÎÎAfter PCI, it is reasonable to use 81 mg of aspirin per day in
preference to higher maintenance doses. (IIa-B)
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