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Reperfusion Options for ST Elevation Myocardial Infarction Patients with Expected Delays to Percutaneous Coronary

David M Larson1, Peter McKavanagh2, Timothy D Henry3

  • 1University of Minnesota Medical School, Minneapolis Heart Institute Foundation, Abbott Northwestern Hospital, 920 East 28th Street, Suite 100, Minneapolis, MN 55407, USA; Division of Cardiology, Ridgeview Medical Center, 500 South Maple Street, Waconia, MN 55387, USA.

Interventional Cardiology Clinics
|June 6, 2017
PubMed

Insights

Primary percutaneous coronary intervention (PCI) is the top treatment for ST-elevation myocardial infarction (STEMI). When 24/7 PCI is unavailable, a pharmacoinvasive strategy or timely transfer is recommended for optimal patient outcomes.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Public Health

Background:

  • Primary percutaneous coronary intervention (PCI) is the gold standard for ST-elevation myocardial infarction (STEMI) reperfusion.
  • Limited 24/7 PCI availability in US hospitals necessitates alternative strategies.
  • Timely transfer and pharmacoinvasive approaches are crucial for STEMI management in non-PCI capable facilities.

Purpose of the Study:

  • To outline the optimal reperfusion strategies for ST-elevation myocardial infarction (STEMI) in the context of varying hospital PCI capabilities.
  • To define the role of pharmacoinvasive strategies and rescue PCI in STEMI management.
  • To emphasize the importance of organized regional STEMI systems for effective treatment delivery.

Main Methods:

  • Review of current guidelines and evidence for STEMI reperfusion.
  • Analysis of treatment pathways based on PCI availability and expected transfer delays.
  • Description of pharmacoinvasive strategy implementation and indications for rescue PCI.

Main Results:

  • Primary PCI is preferred, but transfer is optimal for non-PCI hospitals.
  • A pharmacoinvasive strategy is recommended for delays >120 minutes.
  • Rescue PCI for failed reperfusion/instability; routine PCI within 24 hours for others post-fibrinolysis.

Conclusions:

  • Effective STEMI management requires a multi-faceted approach considering hospital resources.
  • Organized regional STEMI systems with standardized protocols are essential for successful pharmacoinvasive strategy implementation.
  • Prompt and appropriate reperfusion, whether primary PCI, transfer, or pharmacoinvasive, significantly impacts STEMI patient outcomes.

Keywords:
Facilitated PCIInterhospital transferPercutaneous coronary interventionPharmacoinvasiveRuralST segment elevation myocardial infarction

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