Transfer of Patients With STEMI to a PCI-Capable Hospital for
Coronary Angiography After Fibrinolytic Therapy (See Table 8)
ÎÎImmediate transfer to a PCI-capable hospital for coronary angiography
is recommended for suitable patients with STEMI who develop
cardiogenic shock or acute severe HF, irrespective of the time delay
from MI onset. (I-B)
ÎÎUrgent transfer to a PCI-capable hospital for coronary angiography
is reasonable for patients with STEMI who demonstrate evidence of
failed reperfusion or reocclusion after fibrinolytic therapy. (IIa-B)
ÎÎTransfer to a PCI-capable hospital for coronary angiography is
reasonable for patients with STEMI who have received fibrinolytic
therapy even when hemodynamically stablea and with clinical evidence
of successful reperfusion. Angiography can be performed as soon as
logistically feasible at the receiving hospital, and ideally within 24
hours, but should not be performed within the first 2-3 hours after
administration of fibrinolytic therapy. (IIa-B)
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.
Table 8. Indications for Transfer for Angiography After
Fibrinolytic Therapy
COR
LOE
I
B
Urgent transfer for failed reperfusion or reocclusion
IIa
B
As part of an invasive strategy in stable patients with PCI 3-24 h
after successful fibrinolysis
IIa
B
Immediate transfer for cardiogenic shock or severe acute HF
irrespective of time delay from MI onset
a
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.
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