A 55-year-old man presents to a rural emergency department 90 minutes after the onset of central chest pain. ECG shows 3 mm ST elevation in leads II, ...

Question

A 55-year-old man presents to a rural emergency department 90 minutes after the onset of central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest PCI-capable centre is 5 hours away by road and 2 hours by air, and retrieval is delayed by bad weather. There are no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?

Accepted Answer

Immediate intravenous tenecteplase plus antithrombotic therapy

Answer

Urgent transfer for primary PCI despite the delay

Answer

No reperfusion therapy as the time window has passed

Answer

Commence heparin infusion only

Answer

Schedule elective angiography the following day

au-amc MCQ (SBA): ST-elevation myocardial infarction in a rural setting