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Percutaneous coronary intervention after fibrinolysis for acute ST elevation myocardial infarction

Author
Christopher P Cannon, MD
Section Editor
Donald Cutlip, MD
Deputy Editor
Gordon M Saperia, MD, FACC

INTRODUCTION

The preferred reperfusion therapy in many patients with an acute ST elevation (Q wave) myocardial infarction (STEMI) is primary percutaneous coronary intervention (PCI) [1]. Fibrinolytic therapy is given to eligible patients if primary PCI cannot be performed in a timely fashion. (See "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome".)

For patients presenting to a PCI-capable hospital, this is rarely an issue. It is more complicated, however, in patients who first present to a hospital without PCI capabilities. There are a number of studies showing benefit of transfer for primary PCI, even with substantial delays. (See "Primary percutaneous coronary intervention in acute ST elevation myocardial infarction: Determinants of outcome".)

Nevertheless, there are circumstances in which initial fibrinolytic therapy is preferred. A complex issue, which will be reviewed here, is the role and appropriate timing of coronary angiography, and, if appropriate, PCI after fibrinolytic therapy. Historically, there have been a number of approaches to this question, leading to a somewhat confusing lexicon, including:

Rescue or salvage PCI, for apparent failure of fibrinolysis

Urgent PCI, for threatened reocclusion or hemodynamic instability

               

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Literature review current through: Nov 2016. | This topic last updated: Tue Sep 02 00:00:00 GMT+00:00 2014.
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