This protocol addresses patients with a working diagnosis of STEMI in whom ischaemic symptoms have been present for 12 hours or less, primary percutaneous coronary intervention cannot be delivered within the 120-minute window from diagnosis, and there are no contraindications to fibrinolytic therapy.
When timely primary PCI is not available, the approach centres on fibrinolytic therapy initiated as early as possible — with a target of under 10 minutes to the lytic bolus, preferably before hospital arrival. A fibrin-specific fibrinolytic agent is used, supported by antiplatelet co-therapy and anticoagulation.
Immediate transfer to a PCI-capable centre follows the lytic bolus. Further steps — including the timing and conditions for subsequent angiography — are specified in the full protocol.
DOI: 10.1093/eurheartj/ehad191