STEMI: Fibrinolysis

Key points

• If primary PCI cannot be delivered within 120 minutes of when fibrinolysis could be given → give fibrinolysis (e.g. alteplase).
• Typical scenario: district general hospital without on-site cath lab; distant PCI centre.
• Repeat ECG at 90 minutes: if ST elevation has not resolved → transfer to PCI centre regardless (rescue PCI).

Decision points in this pathway

• Can primary PCI be delivered within 120 minutes?
• ST elevation resolved?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.