STEMI treatment

Either PCI or fibrinolytic is appropriate for patients with symptom onset < 12 hours with no contraindication
PCI is better at restoring blood flow when it can be done fast enough
Door to balloon time: 90 minutes
If no PCI is available, consider transfer if can achieve contact to PCI in 120 minutes
Door to needle (tpa) time: 30 minutes
Door to departure time for places without either: 30 minutes¹

Clopidogrel + any heparin + transfer
Aim is: 2 hours (200 minutes) from presentation to artery open is when delay in care is not ok
If hospital has capability: open in 90 minutes (1.5 hours)
if hospital has no primary PCI
- if far away: lytics in 30 minutes
- if close by: 30 minutes at referring, 60 minutes transfer, 30 minutes to do cath. Acceptable transfer delay is 60 minutes between hospitals

ticagrelor or prasugrel are superior than clopidogrel in terms of antiplatelet but higher bleeding risk
PCI capable: very rare to do lytics. Pretty much only if there’s no physical room
at 45 minutes mark, if there is no 50% decrease in ST elevation and still has symptom, that means rescue PCI is needed
Basically, lytics and transfer. Patient will get PCI even after lytics
every one with lytics also gets heparin (different from stroke), antiplateletes

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