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Table 2 Most appropriate reperfusion strategy by time from symptom onset and anticipated treatment delays

From: Achieving the earliest possible reperfusion in patients with acute coronary syndrome: a current overview

Treatment delay Time from symptom onset
< 2 h 2–3 h 3–6 h*
< 60 min Primary PCI Primary PCI or fibrinolysis Primary PCI
60–120 min Fibrinolysis Primary PCI or fibrinolysis Primary PCI
> 120 min Fibrinolysis Fibrinolysis Fibrinolysis
  1. Patients with higher risk, including those with Killip class > 1, may benefit from primary PCI even when there are treatment delays up to 120 min
  2. PCI percutaneous coronary intervention
  3. *If time from symptom onset is greater than 6 h, primary PCI is appropriate regardless of treatment delay
  4. In case of fibrinolytic therapy, immediate transfer to a PCI center after fibrinolysis should be considered for cardiac angiography within 3 to 24 h