Question

A 63-year-old man presents to a rural emergency department 90 minutes after onset of central chest pain. ECG shows 3 mm ST elevation in V2-V4. The nearest PCI-capable centre is 3 hours away by road, and aeromedical retrieval will not arrive for at least 2 hours. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer thrombolysis as soon as possible and arrange transfer for rescue PCI if needed

Answer

Arrange immediate transfer for primary PCI with no thrombolysis

Answer

Start dual antiplatelet therapy only and observe

Answer

Give subcutaneous low molecular weight heparin and discharge if pain settles

Answer

Delay reperfusion until troponin is positive

Practice question