The Living Guidelines: PCI After Failed Fibrinolysis View the Current 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)

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)

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