What are the treatment guidelines for PCI in ST-elevation myocardial infarction (STEMI) (MI, heart attack)?

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

Recommendations for percutaneous coronary intervention (PCI) from the 2013 update of the American College of Cardiology/American Heart Association (ACC/AHA) guidelines for management of ST-elevation myocardial infarction (STEMI), [2]  the 2014 European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EACTS), [127] and 2017 ESC guidelines for myocardial revascularization, [70]  include the following:

  • Primary PCI is indicated in patients with ischemic symptoms shorter than 12 hours and contraindications to thrombolytic therapy (irrespective of the time delay from FMC); and in patients with cardiogenic shock or acute severe heart failure, irrespective of the time delay from MI onset (Class I, level of evidence: A)
  • Primary PCI is reasonable in patients with ongoing ischemia 12-24 hours after symptom onset (Class IIb)

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