STEMI pt who is a candidate for reperfusion

Send to cath lab for primary PCI

FMC-device time 90 min

(Class I, LOE: A)

End

End

End

DIDO, door-in-door-out; FMC, first medical contact; LOC, level of evidence.

Initially seen at a PCI-capable hospital

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

Diagnostic angiography

Medical therapy only

PCI

CABG

DIDO time 30 min

Transfer for primary PCI

FMC-device time as soon as possible and 120 min

(Class I, LOE: B)

Administer fibrinolytic agent within 30 min of arrival when anticipated FMCdevice >120 min

(Class I, LOE: B)

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

(Class IIa, LOE: B)

Transfer for angiography and revascularization within 3-24 h for other pts as part of an invasive strategy^† 

(Class IIa, LOE: B)