View source for Percutaneous coronary intervention rescue PCI (PCI after failed fibrinolysis)

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{{Percutaneous Coronary Intervention}}
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==2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2|pages=296–329 |year=2008 |month=January |pmid=18071078|doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>==
===Immediate (or Emergency) Invasive Strategy and Rescue PCI (DO NOT EDIT)<ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January|pmid=18071078|doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>===
{|class="wikitable"
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| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]]
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' A strategy of [[coronary angiography]] with intent to perform [[PCI]] (or emergency[[CABG]]) is recommended for patients who have received [[fibrinolytic therapy]] and have any of the following:  <nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''a.''' [[Cardiogenic shock]] in patients less than 75 years who are suitable candidates for[[revascularization]].  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''b.''' Severe [[congestive heart failure]] and/or [[pulmonary edema]] (Killip class III).  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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| bgcolor="LightGreen"|<nowiki>"</nowiki>'''c.''' Hemodynamically compromising [[ventricular arrhythmia]]s.  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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{|class="wikitable"
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|colspan="1" style="text-align:center; background:LightCoral"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (Harm)
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|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' A strategy of [[coronary angiography]] with intent to perform [[PCI]] (or emergency [[CABG]]) is not recommended in patients who have received [[fibrinolytic therapy]] if further invasive management is contraindicated or the patient or designee does not wish further invasive care. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki>
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]]
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' A strategy of [[coronary angiography]] with intent to perform [[PCI]] (or emergency[[CABG]]) is reasonable in patients 75 years of age or older who have received [[fibrinolytic therapy]], and are in [[cardiogenic shock]], provided that they are suitable candidates for [[revascularization]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' It is reasonable to perform [[rescue PCI]] for patients with 1 or more of the following'<nowiki>"</nowiki>
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''a.''' Hemodynamic or electrical instability. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''b.''' Persistent [[ischemic symptoms]]. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' A strategy of [[coronary angiography]] with intent to perform [[rescue PCI]] is reasonable for patients in whom [[fibrinolytic therapy]] has failed (ST segment elevation less than 50% resolved after 90 minutes following initiation of[[fibrinolytic therapy]] in the lead showing the worst initial elevation) and a moderate or large area of [[myocardium]] at risk (anterior[[MI]], inferior [[MI]] with right ventricular involvement or precordial [[ST segment depression]]).  ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])'' <nowiki>"</nowiki>
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{|class="wikitable"
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| colspan="1" style="text-align:center; background:LemonChiffon"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]]
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|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' A strategy of coronary angiography with intent to perform PCI in the absence of one or more of the above Class I or IIa indications might be reasonable in moderate- and high-risk patients, but its benefits and risks are not well established. The benefits of rescue PCI are greater the earlier it is initiated after the onset of ischemic discomfort.''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki>
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==References==
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[[Category:Disease]]
[[Category:Cardiology]]

[[Category:Up-To-Date]]
[[Category:Up-To-Date cardiology]]