Reperfusion Therapy for Patients with STEMI - Flowchart
Reperfusion Therapy for Patients with STEMI - Flowchart Myocardial Infarction Myocardial Infarction
«Flowchart»

History suggestive of ACS
EKG: STEMI
Candidate for reperfusion

History suggestive of ACS
EKG: STEMI
Candidate for reperfusion

History suggestive of ACS
EKG: STEMI
Candidate for reperfusion



Send to Cath lab for primary PCI

FMC-device time 90 min

Send to Cath lab for primary PCI

FMC-device time 90 min

Send to Cath lab for primary PCI

FMC-device time 90 min

End

End

End

* Patients with cardiogenic shock or severe heart failure initially seen at a non-PCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset.

* Patients with cardiogenic shock or severe heart failure initially seen at a non-PCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset.

* Patients with cardiogenic shock or severe heart failure initially seen at a non-PCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset.

*

+ Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.

+ Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.

+ Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.

+

ACS, Acute coronary syndrome; CABG, coronary artery bypass graft; Cath, catheterization; DIDO, door-in to door-out; EKG, electrocardiogram; FMC, first medical contact; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.

ACS, Acute coronary syndrome; CABG, coronary artery bypass graft; Cath, catheterization; DIDO, door-in to door-out; EKG, electrocardiogram; FMC, first medical contact; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.

ACS, Acute coronary syndrome; CABG, coronary artery bypass graft; Cath, catheterization; DIDO, door-in to door-out; EKG, electrocardiogram; FMC, first medical contact; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction.

ACS CABG Cath DIDO EKG FMC MI PCI STEMI

Transfer for primary PCI

FMC-device time as soon as possible and 120 min

Transfer for primary PCI

FMC-device time as soon as possible and 120 min

Transfer for primary PCI

FMC-device time as soon as possible and 120 min

Diagnostic angiogram

Diagnostic angiogram

Diagnostic angiogram

Medical therapy only

Medical therapy only

Medical therapy only

PCI

PCI

PCI

CABG

CABG

CABG

Initially seen at a PCI-capable hospital

Initially seen at a PCI-capable hospital

Initially seen at a PCI-capable hospital

Initially seen at a non–PCI-capable hospital*

Initially seen at a non–PCI-capable hospital*

* * Initially seen at a non–PCI-capable hospital

DIDO time 30

DIDO time 30

DIDO time <=30

Administer fibrinolytic agent within 30 min of arrival when anticipated FMC-device >120 min

Administer fibrinolytic agent within 30 min of arrival when anticipated FMC-device >120 min

Administer fibrinolytic agent within 30 min

Urgent transfer for PCI for patients with evidence of failed reperfusion or reocclusion

Urgent transfer for PCI for patients with evidence of failed reperfusion or reocclusion

Urgent transfer for PCI for patients

Transfer for angiography and revascularization within 3-24 hr for other patients as an invasive strategy+

Transfer for angiography and revascularization within 3-24 hr for other patients as an invasive strategy+

+ + Transfer for angiography