STEMI Time-to-Wire Targets — EECC MCQ

Correct answer: A — The 2023 ESC ACS Guidelines recommend a target of ≤60 minutes from STEMI diagnosis to guidewire crossing of the culprit lesion at PCI centres, and ≤120 minutes from first medical contact to wire crossing when transfer from a non-PCI centre is needed

Time is myocardium in STEMI. The 2023 ESC ACS Guidelines specify: (1) STEMI diagnosis to guidewire crossing: ≤60 minutes at PCI-capable centres; (2) first medical contact (FMC) to guidewire crossing: ≤120 minutes when transfer from a non-PCI centre is needed (if >120 min, consider fibrinolysis); (3) door-to-balloon: used as a quality metric (US systems target ≤90 min). Every 30-minute delay increases 1-year mortality by ~7.5%. System requirements: pre-hospital ECG (ambulance diagnosis), direct catheter lab activation (bypassing ED), 24/7 catheter lab availability, and transfer protocols. If the 120-minute target cannot be met: fibrinolysis within 10 minutes of STEMI diagnosis, followed by transfer for angiography within 2-24 hours (pharmacoinvasive strategy — STREAM trial).

Reference: ESC (2023): ACS Guidelines