Treatment
Table 1. Improving Door-to-Baloon (D2B) Times
• Prehospital ECG to diagnose STEMI is used to activate the PCI team while the
patient is en route to the hospital.
• Emergency physicians activate the PCI team.
• A single call to a central page operator activates the PCI team.
• Goal is set for the PCI team to arrive in the catheterization laboratory within 20
minutes after being paged.
• Timely data feedback and analysis are provided to members of the STEMI care team.
Figure 1. Reperfusion Therapy for Patients with STEMI
The purple arrows indicate the preferred strategies. Performance of PCI is
dictated by an anatomically appropriate culprit stenosis.
STEMI patient who is a
candiate for reperfusion
Initially seen at a PCIcapable hospital
Door-in–door-out
(DIDO) time
Initially seen at a non-PCI
capable hospitala
≤30 min
Send to cath lab for
primary PCI
first medical contact
(FMC)-device time
≤90 min (I-A)
Transfer for
primary PCI
FMC-device time
as soon as possible
and ≤120 min
(I-B)
Diagnostic angiogram
PCI
Medical
therapy only
CABG
Urgent transfer for
PCI for patients
with evidence of
failed reperfusion
or reocclusion
(IIa-B)
Administer
fibrinolytic agent
within 30 min
of arrival when
anticipated FMCdevice >120 min
(I-B)
Transfer for
angiography and
revascularization
within 3-24 h for
other patients
as part of an
invasive strategyb
(IIa-B)
Patients with cardiogenic shock or severe heart failure initially seen at a non–PCI-capable
hospital should be transferred for cardiac catheterization and revascularization as soon as possible,
irrespective of time delay from MI onset (I-B).
b
Angiography and revascularization should not be performed within the first 2-3 hours after
administration of fibrinolytic therapy.
a
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