UMEM Educational Pearls

Category: Cardiology

Title: The ECG and Rescue PCI

Keywords: electrocardiography, ECG, STEMI, acute myocardial infarction, rescue PCI (PubMed Search)

Posted: 5/18/2008 by Amal Mattu, MD (Updated: 10/21/2021)
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According to the most recent (2007 Updated) ACC/AHA Guidelines for management of STEMI, the ECG is one of the most important tools to assess for successful reperfusion after thrombolytics. The treating physician should assess the ECG at 90 minutes after administration of lytics. Failure of the ST elevation to decrease by at least 50% in magnitude in the lead with the greatest initial amount of ST elevation is an indication of failed thrombolysis...regardless of whether or not the patient has persistent symptoms. In fact, the Guidelines specifically state that signs and symptoms are considered unreliable indicators of successful reperfusion.

Patients with ECG evidence of failed thrombolysis at 90 minutes should be referred for emergent PCI ("rescue PCI").