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      CHAPTER 13

      Primary and Rescue PCI in STEMI

       Sean Fitzgerald and Holger Thiele

Introduction

      The most effective treatment strategy for acute ST‐elevation myocardial infarction (STEMI) has been shown to be primary percutaneous coronary intervention (PCI), when performed in a timely manner in an expert center. It should be performed making use of the latest evidence‐base guided choice of device and pharmacological adjuncts, which have resulted in improvement in both early and long‐term outcomes. Where timely primary PCI is not possible, a strategy of fibrinolysis with subsequent transfer to a PCI‐capable center should be considered. This chapter considers the framework for organization of primary PCI networks, technical aspects of STEMI treatment including access and device selection, recent developments in STEMI including the approach to the patient with multivessel coronary artery disease with and without cardiogenic shock, optimal adjunctive pharmacological therapy, and the approach to fibrinolysis and rescue PCI.

Timing of intervention in STEMI

      The evidence to date is overwhelming in favor of immediate reperfusion as the most effective strategy