Reperfusion Therapy
A. Fibrinolysis — continued 6. Symptom duration ≤ 12 hours:
> For patients with ischemic symptoms characteristic of acute MI of < 12 hours duration and persistent STE, the ACCP recommends administration of streptokinase, anistreplase, alteplase, reteplase, or tenecteplase over no fibrinolytic therapy (all Grade 1A).
7. Symptom duration ≤ 12 hours, LBBB:
> For patients with ischemic symptoms characteristic of acute MI of ≤ 12 hours duration, and left BBB with associated ST-segment changes, the ACCP recommends fibrinolytic therapy if primary PCI is not readily available (Grade 1B).
8. Symptom duration ≤ 12 hours, posterior MI:
> For patients with ischemic symptoms characteristic of acute MI of ≤ 12 hours duration and ECG findings consistent with a true posterior MI, the ACCP suggests fibrinolytic therapy if primary PCI is not readily available (Grade 2B).
9. Symptom duration 12-24 hours or hemodynamic compromise, persistent STE or LBBB:
> For high-risk patients with ongoing symptoms characteristic of acute MI or hemodynamic compromise and duration of 12 to 24 hours who have persistent STE or left BBB with ST-segment changes, the ACCP suggests fibrinolytic therapy if primary PCI is not readily available (Grade 2B).
B. Fibrinolytic-facilitated PCI
ÎFor patients with acute STEMI undergoing primary PCI: > The ACCP recommends AGAINST the use of fibrinolysis, with or without a GP IIb/ IIIa inhibitor (Grade 1B).
C. Rescue PCI Rescue (also known as salvage) PCI is defined as PCI within 12 h after failed fibrinolysis for patients with continuing or recurrent myocardial ischemia.
ÎFor patients with STEMI who have received fibrinolysis but who have persistent STE (< 50% resolution 90 min after treatment initiation compared with the pretreatment ECG):
> The ACCP recommends rescue PCI should be performed over repeat fibrinolysis or no additional reperfusion therapy (Grade 1B), and suggests as soon as possible and within 2 h of identification of lack of STE resolution (Grade 2C).
