Choice of reperfusion therapy for STEMI

If reperfusion therapy is indicated for STEMI, it may be achieved by:

• percutaneous coronary intervention (PCI)—transluminal coronary balloon angioplasty and stenting
• thrombolytic therapy.

PCI is more beneficial than thrombolytic therapy in reducing mortality, recurrent myocardial infarction and stroke. The benefit of PCI over thrombolytic therapy increases as the time between symptom onset and patient presentation increases.

If PCI is available within 120 minutes of first medical contact, PCI is preferred over thrombolytic therapy.

If PCI cannot be delivered promptly, thrombolytic therapy should be given within 30 minutes of the patient arriving at hospital. In some healthcare services, paramedics can give thrombolytic therapy before the patient reaches hospital.

If the patient is at a centre where PCI is not available and thrombolytic therapy is either contraindicated or has failed (50% or less ST resolution after 60 to 90 minutes and/or continued haemodynamic instability), promptly transfer the patient to a centre where PCI is available.

The National Heart Foundation guidelines for the management of acute coronary syndromes give further detail of optimal timing for reperfusion therapy.