This protocol addresses the specific situation in which a patient presents with a working diagnosis of STEMI, ischaemic symptoms of ≤12 hours, and timely primary PCI was not feasible — so fibrinolytic therapy was initiated as the first reperfusion strategy. It applies when that fibrinolytic treatment does not achieve adequate reperfusion.
Working diagnosis of ST-elevation myocardial infarction; ischaemic symptoms of ≤12 hours duration; timely primary PCI (<120 min from diagnosis) was not feasible; no contraindications to fibrinolysis were present.
Fibrinolytic therapy was initiated as the first reperfusion strategy. This next step is triggered when fibrinolysis fails — defined as ST-segment resolution of less than 50% within 60–90 minutes of fibrinolytic administration, or the presence of haemodynamic or electrical instability, worsening ischaemia, or persistent chest pain. Evidence of re-occlusion or re-infarction with recurrence of ST-segment elevation is also an indication.
When fibrinolysis has not achieved reperfusion, the recommended approach involves immediate angiography directed at the infarct-related artery. The complete criteria, procedural pathway, and timing requirements are contained in the full structured protocol.
DOI: 10.1093/eurheartj/ehad191