This algorithm is for STEMI approach when PCI is not possible <120 min from first medical contact (FMC) & diagnosis by ECG

• If PCI is possible, then immediate transfer to PCI center in preferably <90 min & primary PCI is recommended.

• In patients presenting early (<2 hours after symptom onset) with a large infarct and low bleeding risk, fibrinolysis should be considered if time from first medical contact to balloon inflation is >90 min.

Periprocedural anti thrombotic medication in primary PCI; •Aspirin + ADP-receptor blocker + Injectable anticoagulant. •GP IIb/IIIa inhibitors should be considered for bailout therapy if there is angiographic evidence of massive thrombus, slow or no-reflow or a thrombotic complication (Recommendation Class IIa). •Bivalirudin (with use of GP IIb/IIIa blocker restricted to bailout) is recommended over unfractionated heparin and a GP IIb/IIIa blocker (Recommendations Class I).

Fibrinolytic therapy; •Is recommended within 12 h of symptom onset. •Clopidogrel is indicated in addition to aspirin. •Transfer to a PCI-capable centre following fibrinolysis is indicated in all patients.