Thrombolysis vs PCI Decision (STEMI)
Guides reperfusion strategy in STEMI: primary PCI vs thrombolysis based on time from symptoms, accessibility, and contraindications per ESC/NICE guidelines.
Score interpretation
→ Activate cath lab; dual antiplatelet (aspirin 300mg + ticagrelor 180mg or prasugrel 60mg); unfractionated heparin 70-100 IU/kg IV; target door-to-balloon <90 min; consider GP IIb/IIIa if high thrombus burden
→ Tenecteplase (TNK) weight-adjusted IV bolus if no contraindications; aspirin 300mg + clopidogrel; transfer to PCI centre post-lysis; rescue PCI if thrombolysis unsuccessful at 60-90 min; check for thrombolysis contraindications
→ Cardiogenic shock: primary PCI mandatory even if >120 min delay; thrombolysis contraindicated: PCI only; late presentation (>12h): PCI if ongoing ischaemia or haemodynamic instability only; senior cardiologist and emergency physician joint decision
Interpretation bands for the STEMI Reperfusion. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Alteplase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Streptokinase (STEMI Thrombolysis) · Thrombolytic / STEMI
- Ianalumab (Anti-BAFF — Primary Sjögren's Syndrome) · Anti-BAFF Monoclonal Antibody (B-Cell Survival Factor Inhibitor)
- Labetalol (IV — Hypertensive Emergency) · Combined Alpha-1 and Beta-Adrenergic Blocker
- Colchicine (Pericarditis / Post-MI Inflammation) · Pericarditis / Coronary Inflammation
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Acute Heart Failure · ESC 2021 Heart Failure Guidelines; NICE NG106
- NSTEMI / Unstable Angina · ESC 2020 NSTEMI Guidelines; NICE NG185
- New-Onset Atrial Fibrillation · ESC 2020 AF Guidelines; NICE NG196
- Hypertensive Emergency · ESC/ESH 2018 Hypertension Guidelines; NICE NG136
- Bradycardia Management · Resuscitation Council UK ABCDE; ESC 2021 Pacing Guidelines
- Ventricular Tachycardia / Fibrillation · Resuscitation Council UK ACLS; ESC 2022 Ventricular Arrhythmia Guidelines
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.