Recommendation ID
CG167/2
Question
Primary PCI and fibrinolysis in people with acute STEMI who have a long anticipated transfer time for primary PCI:- In people with acute STEMI who present more than 1 hour after the onset of symptoms, is a primary PCI-related delay of 120–180 minutes associated with outcomes similar to, better or worse than pre-hospital administered fibrinolysis?
Any explanatory notes
(if applicable)
Why this is important:- Primary PCI is the preferred coronary reperfusion therapy provided it can be delivered 'in a timely fashion'. It is suggested that primary PCI is the preferred reperfusion strategy for primary PCI-related delays of at least up to 2 hours. However, there is inadequate evidence to conclude whether primary PCI is still preferable at primary PCI-related time delays of more than 2 hours. No specifically designed randomised controlled trial or observational study has addressed the issue of the extent to which primary PCI-related time delay (and other factors such as presentation delay and a person's risk profile) diminishes the advantages of primary PCI over fibrinolysis. For example, in more geographically remote areas, a short presentation delay together with an anticipated long primary PCI-related delay could favour a strategy of prehospital fibrinolysis. To answer this question, a randomised controlled trial of pre-hospital fibrinolysis versus primary PCI in people with acute STEMI who have a primary PCI-related time delay of 2 hours or more is needed. Primary end points would include cardiovascular and all-cause mortality and other major adverse cardiovascular events.

Source guidance details

Comes from guidance
Myocardial infarction with ST-segment elevation: acute management
Number
CG167
Date issued
July 2013

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 31/07/2013