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.