Primary and Rescue PCI in STEMI

In this chapter, an overview of the management of the patient with acute ST-elevation myocardial infarction (STEMI), including fibrinolytic strategies, is presented. Best practice with regard to organization of primary percutaneous coronary intervention (PCI) networks is reviewed, to ensure as far as possible the performance of PCI within 12 hours of symptom onset, and 120 min from STEMI diagnosis. The evidence base favoring radial access, the lack of convincing evidence for aspiration thrombectomy, and that regarding the most appropriate choice of stent technology is considered. The evidence base for (staged) complete revascularization in STEMI in general is presented. Advances in pharmaceutical therapy and modes of administration, in particular the choice and timing of fibrinolytic therapy, preferring IV bolus dose tenecteplase, are also outlined.

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Interventional Cardiology: Principles and Practice, Third Edition