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News from the American Heart Association
Date:12/10/2007

CI capability should be treated with primary PCI within 90 minutes of first medical contact as a systems goal. The 90-minute goal still stands for hospitals without PCI capability, as long as a patient can be transferred and receive treatment within the 90-minute window. However, for patients who cannot be transferred to a PCI center and undergo PCI within 90 minutes, they should be treated with fibrinolytic therapy within 30 minutes of hospital presentation as a systems goal unless fibrinolytic therapy is contraindicated.

The update also includes clarification of which patients with STEMI are candidates for early intravenous (IV) beta-blocker therapy, now noting that IV beta-blockers should not be administered to STEMI patients who have any of the following: 1) signs of heart failure; 2) evidence of a low output state; 3) increased risk for cardiogenic shock; or 4) other relative contraindications to beta blockade (including second- or third-degree heart block, active asthma, or reactive airway disease).

The update also includes new information on how to make the transition to the catheterization lab for patients who initially received fibrinolytic treatment. This includes facilitated (PCI) and rescue PCI. Facilitated PCI refers to a strategy of planned immediate PCI after administering drugs to reduce blood vessel obstruction before the procedure. Rescue PCI refers to the need for PCI after fibrinolytic treatment has failed to restore blood flow to the heart.

According to the update, potential advantages of facilitated PCI include quicker restoration of blood flow, less heart muscle damage, improved patient stability and greater procedural success. Potential risks include increased bleeding complications, especially in older patients.

Despite the potential advantages, clinical trials of facilitated PCI have not demonstrated benefit in reducing infarct size or improving outcomes. Thus, the update states that full-dose fibrinolyti
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SOURCE American Heart Association; American College of Cardiology
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