Treatment
ÎÎPCI is the recommended method of reperfusion when it can be
performed in a timely fashion by experienced operators. (I-A)
ÎÎEMS transport directly to a PCI-capable hospital for primary PCI is the
recommended triage strategy for patients with STEMI, with an ideal
FMC-to-device time system goal of ≤90 minutes.a (I-B)
ÎÎImmediate transfer to a PCI-capable hospital for primary PCI is the
recommended triage strategy for patients with STEMI who initially
arrive at or are transported to a non–PCI-capable hospital, with a
FMC-to-device time system goal of ≤120 minutes.a (I-B)
ÎÎIn the absence of contraindications, fibrinolytic therapy should be
administered to patients with STEMI at non–PCI-capable hospitals
when the anticipated FMC-to-device time at a PCI-capable hospital
exceeds 120 minutes because of unavoidable delays. (I-B)
ÎÎWhen fibrinolytic therapy is indicated or chosen as the primary
reperfusion strategy, it should be administered within 30 minutes of
hospital arrival.a (I-B)
ÎÎReperfusion therapy is reasonable for patients with STEMI and
symptom onset within the prior 12-24 hours who have clinical
and/or ECG evidence of ongoing ischemia. Primary PCI is the
preferred strategy in this population. (IIa-B)
Evaluation and Management of Patients With STEMI and
Out-of Hospital Cardiac Arrest
ÎÎTherapeutic hypothermia should be started as soon as possible in
comatose patients with STEMI and out-of-hospital cardiac arrest
caused by ventricular fibrillation (VF) or pulseless ventricular
tachycardia (VT), including patients who undergo primary PCI. (I-B)
ÎÎImmediate angiography and PCI when indicated should be performed
in resuscitated out-of-hospital cardiac arrest patients whose initial
ECG shows STEMI. (I-B)
a
The proposed time windows are system goals. For any individual patient, every effort should be made
to provide reperfusion therapy as rapidly as possible.
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