What is the recommended reperfusion strategy for patients with ST-elevation myocardial infarction (STEMI) (MI, heart attack) and symptom onset within the preceding 12-24 hours?

Updated: May 07, 2019
  • Author: A Maziar Zafari, MD, PhD, FACC, FAHA; Chief Editor: Eric H Yang, MD  more...
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Class IIa

Primary PCI is the preferred reperfusion strategy for patients with STEMI and symptom onset within the prior 12 to 24 hours in the presence of clinical and/or ECG evidence of ongoing ischemia. (Level of evidence: B)


The 2012 and 2017 ESC guidelines concur with the ACCF/AHA recommendations and additionally recommend routine blood sampling for serum markers in the acute phase. [4, 70]  However, do not delay initiation of reperfusion therapy for the results. (Class I, level of evidence: C) The 2017 ESC guidelines also indicate the following should be considered for the initial diagnosis (class IIa, level of evidence B for both) [70] :

  • The use of additional posterior chest wall leads (V 7-V 9) when a posterior MI (circumflex occlusion) is highly suspected
  • The use of additional right precordial leads (V 3R and V 4R) in the presence of an inferior MI to identify concomitant right ventricular infarction

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