STEMI: ST-elevation myocardial infarction; PCI: percutaneous coronary intervention; ED: emergency department; AMI: acute myocardial infarction.
* This time includes all time required for transfer and other aspects of care until balloon dilation, thrombectomy, or other definitive percutaneous intervention is performed.
¶ Refer to UpToDate content on selecting a reperfusion strategy in STEMI for more information on patients with late presentation.
Δ For patients who do not undergo either PCI or fibrinolysis, refer to UpToDate content for a discussion of optimal medical management.
◊ The selection and use of a specific fibrinolytic agent and the associated anticoagulant and antiplatelet therapies are discussed in UpToDate content on fibrinolysis in AMI.
§ Patients at high risk of reocclusion should undergo PCI sooner, while low-risk patients can undergo PCI later. More information on the use of angiography and PCI after fibrionlysis for the treatment of STEMI can be found in UpToDate.
¥ Refer to UpToDate content for the details on the absolute and relative contraindications to fibrinolysis in patients with acute STEMI.