The Living Guidelines: PCI After Failed Fibrinolysis Suggest Revisions to the CLASS IIa Guidelines

Any recommendations found on these pages are for education use only. WikiDoc is not a substitute for a licensed healthcare provider. Please see the disclaimers page for important information regarding limitations of the information found here. In suggesting edits to the guidelines, WikiDoc suggests that the following classification scheme be used. Read more about the classification scheme used by the ACC / AHA Guidelines Committee here.

Instructions on How to Edit the Guidelines:
 * Log in
 * Click on "Edit"
 * Type in changes to guidelines
 * Click "Save page" at the bottom of the page

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)