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Acute ST elevation myocardial infarction: Selecting a reperfusion strategy

C Michael Gibson, MS, MD
Duane S Pinto, MD, MPH
Donald Cutlip, MD
Section Editors
Christopher P Cannon, MD
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
James Hoekstra, MD
Deputy Editor
Gordon M Saperia, MD, FACC


For nearly all groups of patients with an acute ST elevation myocardial infarction (STEMI), coronary artery reperfusion of the infarcted artery with either primary percutaneous coronary intervention (PCI) or fibrinolytic therapy improves myocardial salvage and reduces mortality compared to no reperfusion if performed in a timely manner. This is particularly important in the first few hours after symptom onset, when the amount of myocardium salvageable by reperfusion is greatest. As the benefits of reperfusion decline rapidly with time, reperfusion should be implemented as soon as possible. (See "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome", section on 'Time from hospital arrival (door-to-balloon time)' and "Fibrinolysis for acute ST elevation myocardial infarction: Initiation of therapy", section on 'Timing' and 'Short duration of symptoms' below.)

Primary PCI is preferred to fibrinolysis if performed in a timely fashion by an expert operator. When timely primary PCI is not available, fibrinolytic therapy should be administered. (See "Primary percutaneous coronary intervention versus fibrinolysis in acute ST elevation myocardial infarction: Clinical trials".)

This topic will discuss our approach to reperfusion therapy for patients with STEMI. Related topics include:

(See "Percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction".)

(See "Performance of prehospital fibrinolysis".)


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Literature review current through: Sep 2016. | This topic last updated: Feb 18, 2016.
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