| Coronary reperfusion with primary percutaneous coronary intervention (PPCI) or fibrinolytic therapy improves outcomes in patients with acute ST elevation MI (STEMI) or an MI with a new or presumably new left bundle branch block or a true posterior MI. If performed in a timely fashion, PPCI is the reperfusion therapy of choice, preferred over fibrinolysis; it does not carry the risk of intracranial hemorrhage. It is also associated with improved outcomes. [13-15]
The time from hospital arrival to PCI (door-to-balloon time) is an important determinant of benefit, with the best outcomes occurring when the time to PCI is 90 minutes or less.
Patients who are transferred to a PCI center have better outcomes than those treated with fibrinolysis at the presenting hospital if PPCI is delivered according to guideline standards. Most of the benefit in these trials is due to a lower rate of reinfarction after PCI, which is unrelated to the time required for transfer. |
