PCI of an Infarct Artery in Patients Who Initially Were Managed
With Fibrinolysis or Who Did Not Receive Reperfusion Therapy
(Table 10)
ÎÎPCI of an anatomically significant stenosis in the infarct artery should
be performed in patients with suitable anatomy and any of the following:
• Cardiogenic shock or acute severe HF (I-B) or
• Intermediate- or high-risk findings on predischarge noninvasive ischemia testing.
(I-C) or
• Myocardial ischemia that is spontaneous or provoked by minimal exertion during
hospitalization. (I-C)
ÎDelayed PCI is reasonable in patients with STEMI and evidence of
Î
failed reperfusion or reocclusion after fibrinolytic therapy. PCI can be
performed as soon as logistically feasible at the receiving hospital. (IIa-B)
ÎDelayed PCI of a significant stenosis in a patent infarct artery is
Î
reasonable in stablea patients with STEMI after fibrinolytic therapy.
PCI 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)
ÎÎDelayed PCI of a significant stenosis in a patent infarct artery greater
than 24 hours after STEMI may be considered as part of an invasive
strategy in stablea patients. (IIb-B)
ÎÎDelayed PCI of a totally occluded infarct artery >24 hours after STEMI
should NOT be performed in asymptomatic patients with 1- or 2-vessel
disease if they are hemodynamically and electrically stable and do not
have evidence of severe ischemia. (III-B: No Benefit)
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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