For patients with STEMI after ROSC, what is the recommended reperfusion approach?

For patients with STEMI after ROSC, what is the recommended reperfusion approach?

• A. Reperfusion is contraindicated
• B. PCI only
• C. PCI, fibrinolytic therapy, or both
• D. Reperfusion after 48 hours

Answer: (C)

After ROSC in a patient with STEMI, the goal is rapid reperfusion to restore flow in the culprit artery and limit heart muscle damage. Urgent coronary angiography with primary PCI is the preferred approach if it can be done promptly. If PCI isn’t available within a timely window, fibrinolytic therapy is a valid alternative to reperfuse quickly, with a plan to pursue PCI afterward when feasible (a pharmacoinvasive strategy). This is why PCI, fibrinolytic therapy, or both is the best framework: the choice depends on how quickly PCI can be accessed. PCI offers the best outcomes when timely; fibrinolysis is valuable when PCI is not immediately available, and PCI can follow. Reperfusion should be pursued without unnecessary delays in the post-ROSC setting.

After ROSC in a patient with STEMI, the goal is rapid reperfusion to restore flow in the culprit artery and limit heart muscle damage. Urgent coronary angiography with primary PCI is the preferred approach if it can be done promptly. If PCI isn’t available within a timely window, fibrinolytic therapy is a valid alternative to reperfuse quickly, with a plan to pursue PCI afterward when feasible (a pharmacoinvasive strategy). This is why PCI, fibrinolytic therapy, or both is the best framework: the choice depends on how quickly PCI can be accessed. PCI offers the best outcomes when timely; fibrinolysis is valuable when PCI is not immediately available, and PCI can follow. Reperfusion should be pursued without unnecessary delays in the post-ROSC setting.