Selection of reperfusion strategy in STEMI

Primary PCI is the preferred reperfusion strategy for STEMI if it can be done in a timely manner Only 25% of US hospitals are capable of Primary PCI 82% of STEMI pts transferred from non-PCI hospitals for Primary PCI have time delay > 120 min .The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment–elevation myocardial infarction and non–ST-segment–elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment–elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. The amount of myonecrosis per unit time from the moment of coronary occlusion is curvilinear, with the maximum amount of infarction occurring in the first few hours.9 Several clinical studies have confirmed the important relationship between achieving prompt antegrade coronary flow of the infarct artery and improved clinical outcomes for both primary PCI and fibrinolysis. Selecting the optimal reperfusion strategy requires customization based on patient factors including time from symptom onset to first medical contact (FMC), the amount of myocardium at risk, the presence of shock or severe heart failure, the risk of bleeding with fibrinolysis, and the . time required to perform PCI (including transfer to a PCI-capable hospital