The Living Guidelines: STEMI Immediate (or Emergency) Invasive Strategy and Rescue PCI Polling Results for CLASS IIa Guidelines

1- A strategy of coronary angiography with intent to perform PCI (or emergency CABG) is reasonable in patients ≥75 years of age who have received fibrinolytic therapy, and are in cardiogenic shock, provided that they are suitable candidates for revascularization. (Class IIa, Level of Evidence: B)

 AHA / ACC 2007 STEMI Guidelines for Immediate (or Emergency) Invasive Strategy and Rescue PCI Class IIa Recommendation 1 should be CLASS I CLASS IIa CLASS IIb CLASS III

2- It is reasonable to perform rescue PCI for patients with 1 or more of the following:

a. Hemodynamic or electrical instability. (Class IIa, Level of Evidence: C)

 AHA / ACC 2007 STEMI Guidelines for Immediate (or Emergency) Invasive Strategy and Rescue PCI Class IIa Recommendation 2a should be CLASS I CLASS IIa CLASS IIb CLASS III

b. Persistent ischemic symptoms. (Class IIa, Level of Evidence: C)

 AHA / ACC 2007 STEMI Guidelines for Immediate (or Emergency) Invasive Strategy and Rescue PCI Class IIa Recommendation 2b should be CLASS I CLASS IIa CLASS IIb CLASS III

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 < 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). (Class IIa, Level of Evidence: B)

 AHA / ACC 2007 STEMI Guidelines for Immediate (or Emergency) Invasive Strategy and Rescue PCI Class IIa Recommendation 3 should be CLASS I CLASS IIa CLASS IIb CLASS III