American College of Cardiology Foundation / American Heart Association (ACCF/AHA) Joint Committee & the European Society of Cardiology (ESC) state:1,2
- Primary percutaneous coronary intervention (PPCI) is recommended in STEMI patients within 120 min of first medical contact (FMC)
- If PPCI is not achievable within the recommended timeframe, fibrinolysis (pre- or in-hospital) is recommended with immediate transfer to a PCI-capable facility for early coronary angiography and PCI, if indicated
- The combination of fibrinolysis (pharmacological) and PCI (mechanical) treatments is known as the pharmaco-invasive strategy
The need for a pharmaco-invasive strategy
PPCI within 120 min of FMC is the gold standard in the management of STEMI. However, access to timely PPCI is not available to much of the world’s population, due to:3
- Socio-economic status
- Country-specific healthcare resources, practices and policies
- Non-patient-related factors such as transport conditions and location/availability of PCI-capable facilities
- O’Gara P, et al. Guideline for the management of ST-elevation myocardial infarction: A report of the American College of Cardiology Foundation and the American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61:e78-e140.
- Ibanez B, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2017;00:1-66.
- Armstrong PW & Van de Werf F. No STEMI left behind. JAPI 2014;62:469-470.