COR indicates Class of Recommendation; HF, heart failure; LOE, Level of Evidence; N/A, not available; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high- grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia. hospitalization for STEMI.216 Although fractional flow reserve is gests that determination of fractional flow reserve may be useful to assess the hemodynamic significance of potential target lesions in The writing committee encourages research into the benefit of PCI of noninfarct arteries in patients with multi- vessel disease after successful primary PCI (Section 12.6). 6.4. Adjunctive Antithrombotic Therapy to Support Delayed PCI After Fibrinolytic Therapy SeeTable11forasummaryofrecommendationsfromthissection. The selection of adjunctive antiplatelet and anticoagu- lant therapies for use during PCI after fibrinolytic ther- apy should take into account the fibrinolytic agent used, the time since its administration, and the antiplatelet and anticoagulant agents already administered. GP IIb/IIIa inhibi- tors should be used with great caution, if at all, after full-dose fibrinolytic therapy, because this combination is associ- ated with high rates of bleeding and ICH, particularly in the 6.4.1. Antiplatelet Therapy to Support PCI After Fibrinolytic Therapy: Recommendations Class I 1. After PCI, aspirin should be continued indefinite- (Level of Evidence: A) 2. Clopidogrel should be provided as follows: a. A 300-mg loading dose should be given before or at the time of PCI to patients who did not receive a previous loading dose and who are undergoing PCI Table 11. Adjunctive Antithrombotic Therapy to Support PCI After Fibrinolytic Therapy COR LOE References Antiplatelet therapy Aspirin 162- to 325-mg loading dose given with fibrinolytic agent (before PCI). 