Choice of reperfusion therapy in STEMI

What it is

Three things decide between thrombolysis and primary PCI: the availability of a PCI-capable facility, the time from onset of symptoms to presentation with a window of 12 hours, and relative or absolute contraindications to thrombolytic therapy. Reperfusion is most effective within the golden window, the first 12 hours.

How it is treated

At a PCI-capable facility, perform primary PCI directly with a goal of door-to-balloon ≤ 90 minutes.

At a facility that is not PCI-capable, the decision runs on 120 minutes. If transfer for PCI can occur within 120 minutes, transfer the patient to a PCI-capable facility immediately. If transfer will take more than 120 minutes, give thrombolytics immediately, with door-to-needle ≤ 30 minutes. The thrombolytic named is tPA, and tenecteplase is given as the example.