The Living Guidelines: PCI After Failed Fibrinolysis Polling Results for CLASS IIa Guidelines

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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 or older 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 PCI Guidelines Class IIa Recommendation 1 for PCI After Failed Fibrinolysis 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 PCI Guidelines Class IIa Recommendation 2a for PCI After Failed Fibrinolysis should be CLASS I CLASS IIa CLASS IIb CLASS III

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

 AHA / ACC 2007 PCI Guidelines Class IIa Recommendation 2b for PCI After Failed Fibrinolysis 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 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). (Class IIa Level of Evidence: B)

 AHA / ACC 2007 PCI Guidelines Class IIa Recommendation 3 for PCI After Failed Fibrinolysis should be CLASS I CLASS IIa CLASS IIb CLASS III