4.1 STEMI guidelines:
Patients diagnosed with STEMI are immediately assessed for their
eligibility for surgical reperfusion with ineligible patients being
offered pharmaceutical intervention discussed above. The primary PCI
(PPCI) pathway is activated in eligible patients who present within 12
hours of developing symptoms and who are able to have PPCI within 120
minutes of fibrinolysis administration. Otherwise, in patients
presenting after 12 hours of symptom onset, the pathway is activated
only if there is evidence of continued ischaemia. Patients who are
unable to have PPCI within 120 minutes of the fibrinolysis
administration, should be offered a repeat ECG at 60-90 minutes with
follow on PPCI, if an ST-segment-elevation
persists.[33, 34]
PPCI has become the most common treatment for STEMI in the UK, with it
being used to treat ~95% of
cases.[35] In the remaining patients, CABG is the
preferred method of reperfusion. A computed tomography coronary
angiogram is used to assess a patient’s suitability for reperfusion
therapy. This is used to identify the causative lesion/(s) and
corresponding anatomy. Patients are stratified using the SYNTAX score to
assess whether PCI or CABG would be most suitable in this patient.