What is the management approach to ST-elevation myocardial infarction (STEMI) (MI, heart attack) in a hospital with, and a hospital without, primary percutaneous coronary intervention (PCI)?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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For patients presenting to a PCI-capable hospital, emergent coronary angiography and primary PCI should be accomplished within 90 minutes. For patients presenting to a non–PCI-capable hospital, if they cannot be transferred to a PCI-capable hospital within 120 minutes, it is very important to rapidly assess the following to reach a decision about administration of fibrinolytic therapy:

  1. The time from onset of symptoms
  2. The risk of complications related to STEMI
  3. The risk of bleeding with fibrinolysis therapy
  4. The presence of shock or severe heart failure
  5. The time required for transfer to a PCI-capable hospital

Even when interhospital transfer times are short, there may be relative advantages to a strategy of immediate fibrinolytic therapy versus any delay to primary PCI for eligible patients who present within the first 1 to 2 hours after symptom onset. [2]

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