: It is also appropriate to consider emergency interhospital transfer of the patient to a PCI-capable hospital for mechanical revascularization if (1) there is a contraindication to fibrinolysis; (2) PCI can be initiated promptly (within 90 minutes after the patient presented to the initial receiving hospital or within 60 minutes compared to when fibrinolysis with a fibrin-specific agent could be initiated at the initial receiving hospital); or (3) fibrinolysis is administered and is unsuccessful (ie, “rescue PCI”).Secondary nonemergency interhospital transfer can be considered for recurrent ischemia. If the patient arrives at a non–PCI-capable hospital, the door-to-needle time should be within 30 minutes.The purpose of the present guideline is to focus on the numerous advances in the diagnosis and management of patients with STEMI since 1999.
These goals should not be understood as ideal times but rather as the longest times that should be considered acceptable for a given system.
Systems that are able to achieve even more rapid times for treatment of patients with STEMI should be encouraged. Every community should have a written protocol that guides EMS system personnel in determining where to take patients with suspected or confirmed STEMI.
On the basis of observations in the SHOCK Trial Registry and other registries, it is reasonable to extend such considerations of transfer to invasive centers for elderly patients with shock (see VII.
F.5 and Section 7.6.5 of the full-text guidelines).
The treatment options and time recommendations after first hospital arrival are the same. EMS indicates Emergency Medical System; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft surgery; Hosp, hospital; Noninv., Noninvasive.