Question

A 58-year-old man presents to a small rural hospital 90 minutes' drive from the nearest PCI-capable centre. He has had 90 minutes of severe central chest pain with associated diaphoresis. His ECG shows 3 mm ST elevation in leads V2-V4. He arrived by private car; primary PCI at the regional centre would not be possible within 120 minutes of first medical contact. There are no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer IV thrombolysis immediately in the rural hospital and then transfer for angiography

Answer

Arrange transfer for primary PCI only, without giving any reperfusion therapy locally

Answer

Delay reperfusion until helicopter transfer allows PCI at 4-5 hours after symptom onset

Answer

Give full-dose IV unfractionated heparin only and arrange elective angiography

Answer

Provide analgesia and aspirin only because he is outside the thrombolysis window

Practice question