What are the limitations of primary percutaneous coronary intervention (PCI) in the treatment of STEMI?

Updated: Dec 31, 2017
  • Author: Wanda L Rivera-Bou, MD, FAAEM, FACEP; Chief Editor: Erik D Schraga, MD  more...
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Answer

Answer

Although primary PCI is the preferred therapy for STEMI, it has severe logistic restraints: Treatment is delayed by patient transport, emergency department (ED) delay, and preparation of the catheterization laboratory. Furthermore, a skilled intervention team must be available 24 hours a day.

Chakrabarti and colleagues noted that any mortality benefit of primary PCI compared with onsite fibrinolysis was nullified when the time delay to primary PCI was 120 minutes or more. [22]

In the 2013 STEMI Focused Update, the writing committee recommended fibrinolytic therapy when there was an anticipated delay to performing primary PCI within 120 minutes of first medical contact (FMC). FMC was defined as the time at which the EMS provider arrives at the patient’s side. [16]


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