Treatment of ST-elevation myocardial infarction with ischaemic symptom duration of 12 hours or less when primary PCI is achievable within 120 minutes
Clinical scenario
This protocol addresses patients with a working diagnosis of ST-elevation myocardial infarction — characterised by persistent ST-segment elevation or equivalent ECG findings — in whom ischaemic symptoms have been present for 12 hours or less and where the anticipated time from diagnosis to primary percutaneous coronary intervention is under 120 minutes.
- Persistent ST-segment elevation or equivalents on ECG
- Ischaemic symptom onset within 12 hours
- Timely primary PCI reachable (<120 min from diagnosis)
Reperfusion goals
The clinical aim is successful reperfusion: at least 50% ST-segment resolution on ECG, resolution of ischaemic symptoms, and haemodynamic stability.
Approach (partial overview)
In this time-sensitive scenario, the guideline-recommended strategy centres on primary percutaneous coronary intervention as the preferred method of restoring coronary blood flow, combined with antithrombotic therapy. The complete regimen — covering specific agents, sequencing, supportive measures, and contingency options — is defined in the full structured protocol below.
References
DOI: 10.1093/eurheartj/ehad191
- Reperfusion therapy is recommended in all patients with a working diagnosis of STEMI (persistent ST-segment elevation or equivalents) and symptoms of ischaemia of ≤12 h duration.
- A PPCI strategy is recommended over fibrinolysis if the anticipated time from diagnosis to PCI is <120 min.
- In patients with a working diagnosis of STEMI, a PPCI strategy (i.e. immediate angiography and PCI as needed) is the preferred reperfusion strategy, provided it can be performed in a timely manner (i.e. within 120 min of the ECG-based diagnosis).
- Successful reperfusion is generally associated with significant improvement in ischaemic symptoms, ≥50% ST-segment resolution, and haemodynamic stability.
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