If PCI is not available within 120 minutes of arrival, what should be considered?

Fibrinolytic therapy is considered when percutaneous coronary intervention (PCI) cannot be performed within a critical time frame, typically 120 minutes, after a patient presents with STEMI (ST-elevation myocardial infarction). The goal of fibrinolytic therapy is to dissolve the blood clot that is obstructing the coronary artery, thereby restoring blood flow to the heart muscle. This treatment is effective in reducing the mortality and morbidity associated with STEMI when timely PCI is not an option.

Utilizing fibrinolytics within the appropriate timeframe can significantly improve outcomes in patients, making it a crucial consideration in cases where PCI facilities are not immediately accessible. It is important to assess contraindications and potential risks associated with fibrinolytic therapy, but when indicated, it presents an important alternative for achieving myocardial reperfusion.

While aspirin therapy is critical for antiplatelet management and bivalirudin is an anticoagulant used during PCI, neither would specifically address the immediate need for reperfusion in a timely manner. Intravenous antihypertensives might be used to manage blood pressure but do not directly treat the underlying cause of the myocardial ischemia represented by a STEMI.