78 y/o male presents with intermittent crushing chest pain for the past 20 hours but is now pain free. Vitals stable. EKG notes ST elevation in anterior precordial leads and troponin is significantly elevated. Should patient be taken for immediate percutaneous coronary intervention (PCI)?

No.  PCI should not be performed in asymptomatic patients who present more than 12 hours after symptom onset who are hemodynamically and electrically stable. 

If, however, a patient presents within 12 to 24 hours of symptom onset and is hemodynamically or electrically UNstable, has severe congestive heart failure or exhibits evidence of persistent ischemia (chest pain or anginal equivalent), immediate PCI is recommended (class IIa).


Source

Reeder, G. "Overview of the acute management of acute ST elevation myocardial infarction"  Up to Date. January 2012.
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