Treatment
Delayed Invasive Management
Coronary Angiography in Patients Who Initially Were Managed
With Fibrinolytic Therapy or Who Did Not Receive Reperfusion
(Table 9)
ÎÎCardiac catheterization and coronary angiography with intent to
perform revascularization should be performed after STEMI in patients
with any of the following:
• Cardiogenic shock or acute severe HF that develops after initial presentation.
(I-B) or
• Intermediate- or high-risk findings on predischarge noninvasive ischemia testing.
(I-B) or
• Myocardial ischemia that is spontaneous or provoked by minimal exertion during
hospitalization. (I-C)
ÎÎCoronary angiography with intent to perform revascularization
is reasonable for patients with evidence of failed reperfusion or
reocclusion after fibrinolytic therapy. Angiography can be performed
as soon as logistically feasible. (IIa-B)
ÎÎCoronary angiography is reasonable before hospital discharge in
stablea patients with STEMI after successful fibrinolytic therapy.
Angiography can be performed as soon as logistically feasible, 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 9. Indications for Coronary Angiography in Patients
Who Were Managed With Fibrinolytic Therapy or
Who Did Not Receive Reperfusion Therapy
COR
LOE
Cardiogenic shock or acute severe HF that develops after initial
presentation
I
B
Intermediate-or high-risk findings on pre-discharge noninvasive
ischemia testing
I
B
Spontaneous or easily provoked myocardial ischemia
I
C
Failed reperfusion or reocclusion after fibrinolytic therapy
IIa
B
Stablea patients after successful fibrinolysis, before discharge and
ideally between 3 and 24 h
IIa
B
a
14
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.
