Comparison of fluoroscopy time in different catheter-engagement approa | RRCC (2023)

Mostafa Ahmadi,1 Ramin Khameneh Bagheri,1 Faeze Keihanian,2,3 Amin Saeidinia4

1Atherosclerosis Prevention Research Center, Imam Reza Hospital, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 2Pharmaceutical Research Division, Booali Research Center, Mashhad University of Medical Sciences, Mashhad, Iran; 3Cardiology Department, Imam Reza and Qaem Hospitals, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; 4Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Background: Although there is ongoing progress in coronary artery-bypass graft (CABG) surgery and percutaneous coronary intervention techniques and supplies, the risk of cardiac complications remains high compared with the normal population.
Aim: In this study, our aim was to compare fluoroscopy times in engagement of three different catheters in saphenous vein grafts (SVGs) in post-CABG patients undergoing angiography.
Methods: This was a single-center, cross-sectional, comparative study. We evaluated patients with previous CABG referred for invasive coronary diagnostic angiography. Patients having had SVG–obtuse marginal artery, SVG–diagonal, and SVG–posterior descending artery CABG were included. All patients underwent diagnostic angiography by each of a right diagnostic Judkins catheter, right modified Amplatz catheter, and right guiding Judkins catheter. Demographics and clinical history of patients and fluoroscopy time in different groups were evaluated.
Results: A total of 61 patients were evaluated. The distribution of baseline characteristics in the three groups of our study was normal. Mean fluoroscopy time in SVG–obtuse marginal artery was 25.70±6.70 seconds in group A, 22.23±6.51 seconds in group B, and 17.35±7.82 seconds in group C. Mean total fluoroscopy time was 86.35±16.28 seconds in group A, 73.80±10.00 seconds in group B, and 51.90±10.22 seconds in group C, which was significant (P<0.001).
Conclusion: Our data suggest that when we use the guiding Judkins catheter, fluoroscopy time decreases. However, more evaluations are needed with larger-scale studies and identification of other variables.

Keywords: cardiac catheter type, coronary artery-bypass graft surgery, percutaneous coronary intervention, fluoroscopy time


Study population

(Video) Tiger Catheter for Transradial Coronary Angiography

This was a single-center, cross-sectional, comparative study based on data collected from medical records and information obtained and recorded. We evaluated all patients with a history of CABG referred for invasive coronary diagnostic or therapeutic procedures between 2015 and 2017 at the Interventional Cardiology Department of Qaem Hospital, Mashhad University of Medical Sciences by one operator. Patients having had all three of SVG–obtuse marginal (OM) artery, SVG–diagonal, and SVG–posterior descending artery (PDA) CABG were included. We excluded patients with existence of tortuosity >45° in the right femoral access site. All patients underwent diagnostic angiography by femoral access with each of a right diagnostic Judkins catheter, right modified Amplatz catheter, and right guiding Judkins catheter.


Subcutaneous infiltration with 15–20 mL 2% lidocaine was done. Then, the femoral artery was punctured under the inguinal ligament with an 18 G needle (using the modified Seldinger method) with insertion of a 6F or 7F sheath. After that, 2,500 IU UFH was prescribed. Hemostasis was achieved with manual hand compression for 2 hours, or in cases of activated clotting <180 seconds. After fluoroscopy-time calculation in diagnostic angiography, percutaneous coronary intervention was performed in patients who needed it.

Outcomes and definitions

The efficacy of the methods studied was assessed by the success rate of the procedure, determined as completion of a coronary angiography and left ventriculography with adequate coronary and graft opacification, or in therapeutic interventions, taking a residual lesion <20%, without the need to alter the access port. The length of the process and fluoroscopy time were calculated from the start of the arterial puncture to the removal of the last catheter. However, we defined fluoroscopy time as time from the exit of 0.035-gauge wire or end of Right coronary artery angiography till the establishment of a catheter in the aorta root. Procedural safety was assessed by the occurrence of vascular adverse events contributing to the puncture site, such as hematoma >5 cm, severe bleeding, pseudoaneurysm, arteriovenous fistula, arterial occlusion, or need to repair vascular surgery.

Statistical analysis

All data were entered in SPSS version 19.0 and analyzed. Qualitative variables are listed as frequencies and percentages. Quantitative data are indicated as means ± SD. Comparisons between groups were done by c2 or Fisher’s exact test for qualitative variables and Student’s t-test or Mann–Whitney U test for quantitative variables. P<0.05 was considered statistically significant.

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Written informed consent from all patients was obtained for participation in the study. This study was done according to Mashhad University of Medical Sciences ethical committee guidelines and approved by the committee.


A total of 61 patients were evaluated. The mean age of patients was 56.96±11.34 (32–80) years. Most were female (31, 50.8%). Table 1 shows the demographic data of patients.

Table 1 Demographic data of patients in the study

The distribution of baseline characteristics in the three groups of our study can be seen in Table 2.

Table 2 Frequency of baseline characteristics

Notes: Group A, using right diagnostic Judkins catheter; group B, using right modified Amplatz catheter; group C, using right guiding Judkins catheter.

Mean fluoroscopy time in SVG–OM artery was 25.70±6.70 seconds in group A, 22.23±6.51 seconds in group B, and 17.35±7.82 seconds in group C. Other fluoroscopy times can be seen in Table 3 and Figure 1.

Table 3 Fluoroscopy time based on coronary artery-bypass graft

Notes: A, using right diagnostic Judkins catheter; B, using right modified Amplatz catheter; C, using right guiding Judkins catheter. *One-way ANOVA; **Kruskal–Wallis test.

Abbreviations: SVG, saphenous vein graft; OM, obtuse marginal; PDA, posterior descending artery.

Figure 1 Mean fluoroscopy time (FT) in groups and coronary artery-bypass grafts.

Notes: OM time, saphenous vein graft (SVG) to obtuse marginal artery FT; Dig time, SVG to diagonal FT; PDA time, SVG to posterior descending artery FT; OM, obtuse marginal artery; Dig, diagonal; PDA, posterior descending artery.

Mean total fluoroscopy time was 86.35±16.28 seconds in group A, 73.80±10.00 seconds in group B, and 51.90±10.22 seconds in group C, which was significant (P<0.001). There was no significant relationship between demographic data and fluoroscopy time (P>0.05).

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Procedures in cardiological intervention involve high-dose radiation to patients because of the extended use of fluoroscopy, various cine runs, and the difficulty of the procedures.13,14 Innovative catheter designs have been developed to allow diagnostic coronary angiography with a single catheter for both coronary arteries with the aim of reducing vasospasm, radiation dosage, and procedure time. Alternatively, conventional femoral approach catheters are also frequently used for transradial access, eg, Judkins left (JL) for the left coronary artery and Judkins right or Amplatz right I for the right coronary artery.15 Despite the lower estimation of risk of radiation exposure for interventionists, there is growing concern about this issue in cardiac catheterization.16

Long-term, low-dose exposure to radiation in the cardiac catheterization laboratory is related to a limited but not negligibly higher risk of cancers.12 Although there is no definite proof of a link between radiation exposure in the cardiac catheterization lab and higher risk of cancer, there are risk-prediction models in which the risk of cancer is deemed to be increased in lab personnel.12 In the past two decades, radiation-dose exposure for primary operators in cardiac catheterization labs not changed.17 However, advances in recent years in lowering scatter-emitted radiation by fluoroscopy/cine-angiography tools raise expectations of reduced radiation exposure for operators. This can be offset by the increased complexity of different cases that occur in modern cardiac catheterization labs. This problem and an inability to affect radiation dose for operators emphasizes the necessity for new shielding methods for lowering radiation exposure. It has been shown that radiation scatter reduction markedly reduces radiation exposure in both patients and operators during interventional fluoroscopic procedures.18

Catheter choice usually is dependent on such factors as operator experience, training, orientation of ostia, and shape of the aorta. For instance, a large aorta makes it very hard to use a Judkins catheter to reach the vein-graft ostium. Similarly, Amplatz catheters have been used successfully in patients having vein grafts with superior takeoff. Cannulation of grafts on the right side may be dependent on the orientation of the right coronary ostium. Most cases with horizontal takeoff might be cannulated more easily with Judkins right catheters. Some right coronary grafts may have steep takeoff, making Judkins catheter use technically challenging, and may be better served using multipurpose catheters with shallow angulation. Therefore, we consider these factors during procedures. Our results showed that using a right guiding Judkins catheter in post-CABG patients can significantly reduce fluoroscopy time over right diagnostic Judkins and Amplatz catheters in diagnostic angiography. This can help to reduce procedure time and lessen radiation exposure for the patient and operator, lowering the risk of radiation-induced cancer. In this study, we excluded patients who underwent more than one-time try to engagement to the artery, in order to eliminate the confounding factor engagement difficulty. Our study population was limited to these three types of grafts, which was a limitation. This issue was related to the fact that most of our patients had these three types of venous grafts in the center and there were no other venous grafts to be compared. Our results also showed a priority for SVG–OM rather than SVG–diagonal or SVG–PDA grafts. This priority can be due to the anterolateral position of the SVG–OM ostium and higher level of its origin, which allows more time to maneuver and higher probability of engagement. There have been few investigations to compare catheter shape and rate of procedural success for the transfemoral approach in coronary angiography. Vorpahl et al15 demonstrated that fluoroscopy time was significantly less in a Tiger II (2.4±1.5 minutes) than a conventional catheter (3.1±2.5 minutes; P=0.01), a major reason for which was the higher use of supplemental catheters (crossover) in Tiger II. In addition, fluoroscopy times after crossover were significantly greater in the conventional catheter (5.8±0.7, P=0.0001) than the Tiger II (7.6±3.0 minutes, P=0.0001). Fluoroscopy time was very similar between the conventional catheter and the Tiger II without crossover (2.2±1.2 min vs 2.3±1.2 min). In 2006, Kim et al19 made a comparison of the Tiger II and Judkins left catheter by measuring procedure time and fluoroscopy time. They found superiority for right coronary angiographic quality with the Tiger II and a marked benefit in process and fluoroscopy time without difference for left coronary angiographic quality. Overall, fluoroscopy time in the prospective randomized trial of Kim et al was significantly lower in the Tiger II (1.55 minutes) vs conventional catheter (2.3 minutes).19 SVG markers assist the angiographer by pinpointing the ostium of the aorta vein-graft anastomosis and by demonstrating the number of vein-graft ostia that must be cannulated at catheterization, significantly decreasing fluoroscopy time. However, in this study, we routinely used the markers by angiographer and all of the processes were performed in the same way in all three groups.

By reducing fluoroscopy time in our study with the right guiding catheter, the risk of cancer in patients and operators can be lowered. Another benefit is better engagement and lowering manipulation that can lead to lower rate of emboli risk in patients. Also, by lowering fluoroscopy time, the usage of dye will decrease and thus lower the rate of contrast-induced nephropathy. However, assessment of contrast-induced nephropathy in this study was not logical, because we did not have any patient with it.


There are several limitations to our study. The design was based on the existence of previous cases, and this made our study affected by some confounding factors. While during patient engagement, these points were followed, we did not access documented reports for all cases. We plan future studies based on this report and hope to resolve these limitations. In our setting, the three reported vein grafts were the most frequent, and we did not have other venous grafts. The findings from our study are hypothesis-generating and may need further validation by a larger prospective randomized trial.

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This study and other similar publications highlight the importance of catheter choice and operator training as key components in successful procedures. Our data suggest that when the guiding Judkins catheter is used, fluoroscopy time will decrease and lead to the benefits mentioned. However, more evaluations are needed in the form of large-scale studies and identification of other variables, eg, contrast volume, success in engagement, and other confounding factors.


We thank all nurses of the Cardiac Catheterization Laboratory of Qaem Hospital for their cooperation in performing the study.


The authors report no conflicts of interest in this work.


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Kim MS, Wang TY, Ou FS, et al. Association of prior coronary artery bypass graft surgery with quality of care of patients with non-ST-segment elevation myocardial infarction: a report from the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines. Am Heart J. 2010;160(5):951–957.


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What is the fluoro time of PCI? ›

Mean fluoroscopy time (FT) in the patients subjected to PCI was 9.61±6.07 minutes while in cases for CA 4.17±4.13 minutes.

How is fluoroscopy used in a cardiac catheterization lab? ›

In cardiac catheterization , fluoroscopy is used as an adjunct to enable the doctor to see the flow of blood through the coronary arteries in order to evaluate the presence of arterial blockages.

Does Cath Lab use fluoroscopy? ›

There are two different sequences of radiation exposure in the cath lab – fluoroscopy and acquisition (cine). Fluoroscopy is used for catheter, balloon and stent placement, and involves 50–90 % of the total X-ray operation time.

What is the most commonly used technique or approach in cardiac catheterization? ›

Cardiac Catheterization Techniques

Traditionally, cardiologists use the femoral artery in the groin to start catheterization. But whenever possible, we use the radial artery in the wrist. This newer, less invasive approach has not yet been widely adopted. For some people, we still need to use the femoral approach.

What is the ideal time for PCI? ›

Primary PCI

Fibrinolytic therapy is most effective within 3 hours of symptom onset. The best outcomes occur when primary PCI is performed with a door-to-balloon time of less than 90 minutes and when symptom onset was less than 12 hours before the intervention.

What is real-time in fluoroscopy? ›

Fluoroscopy is a method that provides real-time X-ray imaging. This is especially useful for guiding a variety of diagnostic and interventional procedures. The ability of fluoroscopy to display motion is provided by a continuous series of images produced at a maximum rate of 25-30 complete images per second.

What is the procedure time for cardiac catheterization? ›

The whole cardiac catheterization procedure takes about 30 to 60 minutes. You'll be given medicine to help you relax, but you'll be awake during the procedure. First, the doctor will insert an intravenous, or IV line into one of the blood vessels in your groin or neck.

What is the recovery time for a heart catheterization? ›

Most people can return to their normal activities the day after the procedure, though you'll want to avoid strenuous exercise and lifting heavy objects for two weeks. Some additional time may be needed if a treatment was done during your cardiac catheterization. Your doctor will advise you accordingly.

What are fluoroscopy procedures for urinary system? ›

Cystography is an imaging test that can help diagnose problems in your bladder. It uses X-rays. They may be X-ray pictures or fluoroscopy, a kind of X-ray "movie." During cystography, the healthcare provider will insert a thin tube called a urinary catheter and inject contrast dye into your bladder.

What are the disadvantages of fluoroscopy? ›

  • Radiation doses are usually higher than in common imaging like x-rays. ...
  • Some fluoroscopy procedures are longer and use more radiation than others. ...
  • Contrast dye, if used, can produce an allergic reaction in some people.

Does fluoroscopy always use contrast? ›

Some fluoroscopy procedures require a contrast dye, which is a safe substance that makes a part of your body show up more clearly on an X-ray.

What are the types of fluoroscopy? ›

Types of Fluoroscopy
  • Musculoskeletal Fluoroscopy. ...
  • Barium Swallow. ...
  • Fluoroscopic Enteroclysis. ...
  • Fluoroscopic Defecography. ...
  • Fluoroscopic Small Bowel Follow Through. ...
  • Fluoroscopic IVP (Intravenous Pyelogram) ...
  • A Fluoroscopic VCUG (voiding cystourethrogram) ...
  • Fluoroscopic HSG (hysterosalpingogram)

What is the most preferred site for cardiac catheterization? ›

For cardiac catheterization procedures that require arterial access, the 2 common sites used include the common femoral artery and radial artery.

What are the 2 types of cardiac catheterization? ›

There are two types of cardiac catheterization procedures: right heart catheterization (RHC) and left heart catheterization (LHC).

What is the most important assessment before cardiac catheterization? ›

Before a cardiac catheterization, you will likely have your blood pressure and pulse checked. You may be asked to use the toilet to empty your bladder. You may be asked to remove dentures and any jewelry, especially necklaces that could interfere with pictures of the heart.

Why PCI within 90 minutes? ›

Based on the association between shorter times to reperfusion and lower mortality in patients with ST-segment–elevation myocardial infarction (STEMI),1,2 consensus guidelines recommend a door-to-balloon (D2B) time of 90 minutes or less for STEMI patients undergoing primary percutaneous coronary intervention (PCI).

What is the door to needle time for PCI? ›

Depending on the available in-hospital facilities, the goal for patients with STEMI should be to achieve a door-to-needle time within 30 minutes (for thrombolysis) and a door-to-balloon time within 90 minutes (for PCI).

What is the maximum time for primary PCI? ›

According to the current guidelines for treatment of ST-elevation myocardial infarction (STEMI), percutaneous coronary intervention (PCI) should be performed within 90min of first medical contact and total ischemic time should not exceed 120min.

What is the difference between continuous and pulsed fluoroscopy? ›

Continuous fluoroscopy allows for real-time imaging but could deliver larger radiation doses to the patient. Pulsed fluoroscopy delivers bursts of radiation at set intervals, reducing fluoroscopy times.

What is interrogation time in fluoroscopy? ›

Interrogation Time:the time for the x-ray tube to be turned on and for kVp & mA levels to reach selection. This is less than 1ms with DF due to the incorporation of HF generators. Extinction Time: The time for the x-ray tube to be turned off. This is less than 1ms with DF due to the incorporation of HF generators.

Why is real-time imaging important? ›

In a like manner, real-time scanners facilitate the determination of the size and configuration of organs that can be encompassed entirely within their limited fields of view because the image plane can be readily oriented to both the true long and short axis of the particular organ.

What is door to balloon time? ›

The door-to-balloon (D2B) time is the time from the arrival at the emergency department of patients with ST segment elevation myocardial infaction (STEMI) until a catheter guidewire crosses the culprit lesion in the cardiac catheterization lab.

What is the difference between a right and left heart catheterization? ›

Right heart catheterization measures pressure in your right atrium, right ventricle and pulmonary artery. Left heart catheterization measures pressure in your left ventricle, assesses your aorta and aortic valve, and checks your coronary arteries for blockages.

Do you fast for heart catheterization? ›

Clear fluids up to the time of the procedure and no food for at least 2 hours before the procedure. Clear fluids and food up to the time of the procedure. Non fasting group is allowed for clear fluids and food up to the time of the procedure.

Which is most common complication during cardiac catheterization? ›

What are the risks of cardiac catheterization?
  • Bleeding or bruising where the catheter is put into the body (the groin, arm, neck, or wrist)
  • Pain where the catheter is put into the body.
  • Blood clot or damage to the blood vessel that the catheter is put into.
  • Infection where the catheter is put into the body.

How long is recovery time for angiogram? ›

Most people feel fine a day or so after having the procedure. You may feel a bit tired, and the wound site is likely to be tender for up to a week. Any bruising may last for up to 2 weeks.

Why does my leg hurt after a heart cath? ›

Nerve pain after a femoral cath is a known complication. It can happen if the femoral nerve gets pinched during the needle stick or catheter manipulation -- or sometimes during the manual compression of the artery, or even by the vascular closure device that is sometime used to seal the wound.

What is the most common fluoroscopy procedure? ›

The most common uses of fluoroscopy include: Barium swallow or barium enema. In these procedures, fluoroscopy is used to show the movement of the gastrointestinal (digestive) tract.

What are the procedures done with fluoroscopy? ›

Fluoroscopy is used in a wide variety of examinations and procedures to diagnose or treat patients. Some examples are: Barium X-rays and enemas (to view the gastrointestinal tract) Catheter insertion and manipulation (to direct the movement of a catheter through blood vessels, bile ducts or the urinary system)

What should be recorded during a fluoroscopy procedure? ›

Each facility that uses fluoroscopic x-ray systems shall maintain a record of the cumulative fluoroscopic exposure time used and the number of spot films for each examination. This record shall indicate patient identification, type of examination, date of examination, and operator's name.

What are two major risks are associated with fluoroscopy use? ›

A: The two major risks associated with fluoroscopy are radiation-induced injuries to the skin and underlying tissues (“burns”) and the small possibility of developing a radiation-induced cancer some time later in life.

What poses the most risk to personnel during fluoroscopy? ›

Excerpt. Radiation safety is a concern for patients, physicians, and staff in many departments, including radiology, interventional cardiology, and surgery. Radiation emitted during fluoroscopic procedures is responsible for the greatest radiation dose for medical staff.

What not to do before a fluoroscopy? ›

It's essential you don't drink or eat anything after midnight the night before your exam. Don't use mints, gum or cigarettes after midnight either. Bring any order your doctor gave you to your appointment. This procedure requires images on a timed basis to assess the small bowel.

What is the primary disadvantage of using fluoroscopy as an imaging technique? ›

Fluoroscopy can result in relatively high radiation doses, especially for complex interventional procedures (such as placing stents or other devices inside the body) which require fluoroscopy be administered for a long period of time. CT - many X-ray images are recorded as the detector moves around the patient's body.

What are 3 benefits of the fluoroscopy exam? ›

A fluoroscope allows medical staff to see bones and also helps physicians to identify soft tissue pathology. Fluoroscopy helps reduce the invasiveness of a surgery. Prior to fluoroscopy, physicians had to surgically open a patient to see the form and function of a certain body part.

How accurate is a fluoroscopy? ›

Fluoroscopy is considered the most accurate method to evaluate the diaphragm, yet most existing methods for measuring diaphragmatic mobility using fluoroscopy are complex.

What is an alternative to fluoroscopy? ›

The most frequently used alternative imaging approaches include intracardiac echocardiography, cardiac MRI guidance, and 3D electroanatomic mapping systems. Electroanatomic mapping and intracardiac echocardiography originally used to augment fluoroscopy imaging are now replacing the older imaging technique.

What is the difference between fluoroscopy and interventional fluoroscopy? ›

Unlike a traditional X-ray that takes a single image at a time – a snapshot – fluoroscopy sends a constant (or near-constant) beam to provide live images. Interventional fluoroscopy works by sending an X-ray beam through the part of the body being examined – the region of interest (the ROI).

Why would a doctor order a fluoroscopy? ›

You might need a fluoroscopy exam to help diagnose problems with your bones, joints or organs, including the heart, bladder, kidneys and reproductive organs. Health care providers often use fluoroscopy in the gastrointestinal tract, where it can help diagnose: Inflammation. Strictures, or narrowing in the intestines.

What is the best position for catheterization? ›

Ensure patient privacy and have patient in supine position. Place waterproof sheet and/or kidney dish between patient legs. Perform hand hygiene & don gloves. Gently withdraw catheter on exhale if possible, with rotation movements if necessary.

What is the best vein to use for right cardiac catheterization? ›

Medially located forearm veins are superior for access in comparison to laterally situated veins, due to their straighter course for wire and catheter navigation.

Which vein is best for cardiac catheterization? ›

Background and Objectives. Right heart catheterization is traditionally performed using a femoral vein approach that involves admission, bed rest, and risks of bleeding and hematoma. Recent studies have confirmed safety of the use of forearm vein for right cardiac catheterization.

What is an alternative to cardiac catheterization? ›

Cardiac CT Provides Reliable, Noninvasive Alternative to Angiography in Diagnosing Coronary Artery Disease. Data from the DISCHARGE trial provides evidence demonstrating computed tomography could be a safe alternative to catheterization in patients with stable chest pain and suspected CAD.

What type of sedation is used for cardiac catheterization? ›

Percutaneous intervention (PCI)

PCI is usually performed under mild sedation under the supervision of a cardiologist. Anesthesiologists are usually required when patient is in respiratory distress or haemodynamically is unstable due to acute MI.

What is the timeline for a cardiac cath? ›

The whole cardiac catheterization procedure takes about 30 to 60 minutes. You'll be given medicine to help you relax, but you'll be awake during the procedure.

How long is the recovery time for a heart catheterization? ›

Complete recovery takes a week or less. Keep the area where the catheter was inserted dry for 24 to 48 hours. If the catheter was inserted into your arm, recovery is often faster.

What medication is given before cardiac catheterization? ›

Your physician will provide a prescription for this pre-medication. Plan to take four baby aspirins (325 mg) prior to your catheterization as instructed by your physician. If you are on Brilinta (ticagrelor), you will only need 81 mg of aspirin.

What is the time frame for primary PCI? ›

Healthcare professionals ensure that they offer primary PCI, as the preferred coronary reperfusion strategy, as soon as possible but within 120 minutes of when fibrinolysis could have been given to adults with acute STEMI who present within 12 hours of the onset of symptoms.

What is the time window for primary PCI? ›


can be achieved within 90min of arrival to the ED. symptom onset within the previous 12h.

What is the ACLS time goal for PCI? ›

Reperfusion goals.

The door to balloon inflation goal for PCI is 90 minutes. The door to needle goal for fibrinolysis is 30 minutes.

What is the door-to-balloon time for PCI? ›

Among patients with STEMI and cardiogenic shock, primary PCI is should be done within a timely door-to-balloon time (less than 90 minutes). Although fibrinolytic therapy is less effective, it is indicated when timely PCI is unlikely to occur and when MI and cardiogenic shock onset are within 3 hours.

Is door-to-balloon time 90 or 120 minutes? ›

The American College of Cardiology (ACC), American Heart Association (AHA) and the European Society of Cardiology have all recommended a door to balloon (D2B) time of 120 minutes from the first medical contact or 90 minutes from the patient presentation to the first balloon inflation [2,4].

Can PCI be done after 12 hours? ›

WHAT IS KNOWN. Timely reperfusion with percutaneous coronary intervention within 12 hours of symptom onset is first-chose treatment in ST-segment–elevation myocardial infarction (STEMI). Up to 40% of all patients with STEMI present later than 12 hours after symptom onset.

What is the time goal for primary PCI in a STEMI patient transported directly to a PCI capable hospital for primary PCI? ›

The 2013 American College of Cardiology Foundation/American Heart Association guidelines for STEMI recommend that hospitals capable of primary PCI should treat patients within 90 minutes of contact with the medical system.

What ACLS test is done within 25 minutes? ›

Within 25 minutes of arrival at the emergency department, the stroke team or designee should review the patient's history, establish a timeline of symptom onset, and perform a neurologic examination using either the NIH Stroke Scale or the Canadian Neurological Scale.


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