Table 13.

Recommendation for selection of reperfusion strategy.

Recommendations:
For patients within 12 h of symptom onset and with persistent ST-segment elevation or new or presumed new left bundle branch block, early mechanical or pharmacological reperfusion should be performed as early as possible
The reperfusion therapy should be considered if there is clinical and/or electrocardiographic evidence of ongoing ischaemia, between 12 and 24 h. Primary PCI is preferred in these patients
Routine PCI of a totally occluded artery >24 h after symptom onset in stable patients without signs and symptoms of ischaemia is not recommended
Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 h’ duration who have contraindications to thrombolytic therapy, irrespective of the time delay from FMC
Primary PCI should be performed in patients with STEMI presenting with cardiogenic shock, hemodynamic and electrical instability irrespective of time delay from symptom onset
Thrombolytic therapy is recommended within 12 h of symptom onset in patients without contraindications if primary PCI cannot be performed by an experienced team within 120 min of FMC(preferably within 90 min)
Fibrin specific agents have some advantages over streptokinase but are more expensive and not widely available. Whereas Streptokinase is cheap, easily available and is the most frequently used thrombolytic agent in India. However, the final decision of choice of thrombolytic agent is at the discretion of the treating physician and the patient.
All thrombolysed patients should be considered for PI therapy within 3–24 h, if feasible.
All patient with failed thrombolysis should undergo prompt Rescue PCI