Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation:

  • Immediately assess eligibility (irrespective of age, ethnicity or sex) for coronary reperfusion therapy (either primary percutaneous coronary intervention [PCI] or fibrinolysis) in people with acute ST-elevation myocardial infarction (STEMI).

  • Do not use level of consciousness after cardiac arrest caused by suspected acute STEMI to determine whether a person is eligible for coronary angiography (with follow-on primary PCI if indicated).

  • Deliver coronary reperfusion therapy (either primary PCI or fibrinolysis) as quickly as possible for eligible people with acute STEMI.

  • Offer coronary angiography, with follow-on primary PCI if indicated, as the preferred coronary reperfusion strategy for people with acute STEMI if:

    • presentation is within 12 hours of onset of symptoms and

    • primary PCI can be delivered within 120 minutes of the time when fibrinolysis could have been given.

  • Offer fibrinolysis to people with acute STEMI presenting within 12 hours of onset of symptoms if primary PCI cannot be delivered within 120 minutes of the time when fibrinolysis could have been given.

  • Consider coronary angiography, with follow-on primary PCI if indicated, for people with acute STEMI presenting more than 12 hours after the onset of symptoms if there is evidence of continuing myocardial ischaemia.

  • Offer coronary angiography, with follow-on primary PCI if indicated, to people with acute STEMI and cardiogenic shock who present within 12 hours of the onset of symptoms of STEMI.

  • Offer an electrocardiogram to people treated with fibrinolysis, 60–90 minutes after administration. For those who have residual ST-segment elevation suggesting failed coronary reperfusion:

    • offer immediate coronary angiography, with follow-on PCI if indicated

    • do not repeat fibrinolytic therapy.

  • If a person has recurrent myocardial ischaemia after fibrinolysis, seek immediate specialist cardiological advice and, if appropriate, offer coronary angiography, with follow-on PCI if indicated.

  • When commissioning primary PCI services for people with acute STEMI, be aware that outcomes are strongly related to how quickly primary PCI is delivered, and that they can be influenced by the number of procedures carried out by the primary PCI centre.

  • National Institute for Health and Care Excellence (NICE)