Door to balloon time = 90 minutes
Transfering to PCI capable facility vs. Fibrinolysis
“In general, percutaneous coronary intervention (PCI) is preferred because it leads to improved outcomes compared to fibrinolysis when performed in high-volume medical facilities without treatment delays.
If a patient’s first medical contact is at a PCI-capable hospital or the time from first medical contact to device time is less than 120 minutes, PCI is the preferred intervention for patients presenting with symptoms for less than 12 hours.” ABFM explanation
Transfer patient to a PCI capable facility if the following two are true or expected to be true.
< 12 hours since symptom onset.
<120 minutes from first medical contact to device time in a PCI capable facility.
Do fibrinolysis if it is still < 12 hours from symptom onset but you can’t get the patient to PCP capable facility to get the cath in <120 minutes from first medical contact to device time.
“If there are absolute contraindications to fibrinolysis (such as a history of an ischemic stroke within the past 3 months), then PCI is preferred even if the transport time will not be short. In cases where the onset of symptoms was more than 12 hours ago but less than 24 hours ago and evidence of ongoing ischemia exists, it is still reasonable to pursue reperfusion therapy, and PCI would be the preferred strategy if it is available.”