Template:ACC/AHA 2007 STEMI focused update recommendation

Class I

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:
 * a. Cardiogenic shock in patients less than 75 years who are suitable candidates for revascularization (Level of Evidence: B)
 * b. Severe congestive heart failure and/or pulmonary edema (Killip class III) (Level of Evidence: B)
 * c. Hemodynamically compromising ventricular arrhythmias (Level of Evidence: C)

Class IIa

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. (Level of Evidence: B)

2. It is reasonable to perform rescue PCI for patients with 1 or more of the following:
 * a. Hemodynamic or electrical instability. (Level of Evidence: C)
 * b. Persistent ischemic symptoms. (Level of Evidence: C)

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). (Level of Evidence: B)

Class IIb

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. (Level of Evidence: C)

Class III

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. (Level of Evidence: C)