IABP indicates intra-aortic balloon pump; PCI, percutaneous coronary interven- tion; and SCAI, Society for Cardiovascular Angiography and Interventions. Adapted with permission from Dehmer et al.352 Table 7. SCAI Expert Consensus Document Requirements for Primary PCI and Emergency Aortocoronary Bypass Surgery at Hospitals Without On-Site Cardiac Surgery Avoid intervention in patients with 50% diameter stenosis of left main artery proximal to infarct-related lesion, especially if the area in jeopardy is relatively small and overall LV function is not severely impaired Long, calcified, or severely angulated target lesions at high risk for PCI failure with TIMI flow grade 3 present during initial diagnostic angiography Lesions in other than the infarct artery (unless they appeared to be flow limiting in patients with hemodynamic instability or ongoing symptoms) Lesions with TIMI flow grade 3 that are not amenable to stenting in patients with left main or 3-vessel disease that will require coronary bypass surgery Culprit lesions in more distal branches jeopardizing only a modest amount of myocardium when there is more proximal disease that could be worsened by attempted intervention Transfer emergently for coronary bypass surgery patients with High-grade left main or 3-vessel coronary disease with clinical or hemodynamic instability after successful or unsuccessful PCI of an occluded vessel and preferably with IABP support Failed or unstable PCI result and ongoing ischemia, with IABP support during transfer IABP indicates intra-aortic balloon pump; LV, left ventricular; PCI, percuta- neous coronary intervention; SCAI, Society for Cardiovascular Angiography and Interventions; and TIMI, Thrombolysis in Myocardial Infarction. Adapted with permission from Dehmer et al.352 gram [ECG] changes, elevated troponin, high Global Registry of Acute Coronary Events score), recurrent symptoms, threat- ened viable myocardium, CKD, and larger ischemic burden (Appendix 4E). 