STEMI Questions and Answers
Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non-PCI-capable hospital, with an FMC-to-device time system goal of 120 minutes or less*
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STEMI Questions and Answers
Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage
strategy for patients with STEMI who initially arrive at or are transported to a non-PCI-
capable hospital, with an FMC-to-device time system goal of 120 minutes or less* -
answer
In the absence of contraindications, fibrinolytic therapy should be administered to
patients with STEMI at non-PCI-capable hospitals when the anticipated FMC-to-device
time at a PCI capable hospital exceeds 120 minutes because of unavoidable delays -
answer
When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it
should be administered within 30 minutes of hospital arrival* - answer
interhospital transfer to a PCI-capable
hospital is the recommended triage strategy if primary PCI consistently can be
performed within 120 minutes of FMC - answer
Fibrinolytic therapy, in the absence of contraindications to its use, should be
administered within 30 minutes of first door arrival - answer
facilitated PCI - answer full- or half-dose fibrinolysis, with or without administration of
a glycoprotein (GP) IIb/IIIa receptor antagonist, with immediate transfer for planned PCI
within 90 to 120 minutes
rescue PCI - answer transfer for PCI of patients who demonstrate findings of failed
reperfusion with fibrinolysis
pharmacoinvasive
strategy - answer refers to the administration of fibrinolytic therapy
either in the prehospital setting or at a non-PCI-capable hospital, followed by immediate
transfer to a PCI-capable hospital for early coronary angiography and PCI when
appropriate.
Patients with STEMI who are best suited for
immediate interhospital transfer for primary PCI without fibrinolysis are those patients
who present with shock or other high-risk features, those with high bleeding risk with
fibrinolytic therapy, and those who present 3 to 4 hours after symptom onset and who
have short transfer times - answer
Patients best suited for initial fibrinolytic therapy are those with low bleeding risk who
present very early after symptom onset (2 to 3 hours) to a non-PCI-capable hospital and
who have longer delay to PCI - answer
, A meta-analysis of 6 higher-quality
RCTs revealed an approximately 60-minute reduction in time from symptom onset to
delivery of fibrinolytic therapy with prehospital versus hospital-based administration, with
a corresponding 17% reduction in risk of all-cause hospital mortality - answer
Therapeutic hypothermia should be started as soon as possible in comatose patients
with STEMI and out-of-hospital cardiac arrest caused by ventricular fibrillation (VF) or
pulseless ventricular tachycardia (VT), including patients who undergo primary PCI -
answer
23% of out-of-hospital cardiac arrest cases have a
shockable initial rhythm (primarily VF), the majority of
neurologically intact survivors come from this subgroup - answer
rate of survival to hospital discharge
with any first recorded rhythm is only 7.9% (175); the rate of survival in patients who are
in VF initially is much higher (median 22%, range 8% to 40%) - answer
Two RCTs have reported improved rates of neurologically intact survival to hospital
discharge when comatose patients with out-of-hospital VF or nonperfusing VT cardiac
arrest were cooled to 32°C to 34°C for 12 or 24 hours beginning minutes to hours after
the return of spontaneous circulation - answer Cooling should begin before or at the
time of cardiac
catheterization
Primary PCI should be performed in patients with STEMI and ischemic symptoms of
less than 12 hours' duration - answer
Primary PCI should be performed in patients with STEMI and cardiogenic shock or
acute severe HF, irrespective of time - answer
Primary PCI is reasonable in patients with STEMI if there is clinical and/or ECG
evidence of ongoing ischemia between 12 and 24 hours after symptom onset - answer
Manual thrombus aspiration at the time of primary PCI
results in improved tissue perfusion and more complete ST resolution, though not all
studies have
shown positive results - answer
Two RCTs (221,235) and a meta-analysis (234) support the use of manual aspiration
thrombectomy during primary PCI to improve microvascular reperfusion and to
decrease deaths and
adverse cardiac events - answer However, infarct size was not reduced by
manual aspiration thrombectomy in the INFUSE-AMI. The trial was underpowered
to detect differences in clinical outcomes
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