Question

A 63-year-old man presents to a small rural emergency department 45 minutes after the onset of crushing central chest pain. His ECG shows 3 mm ST elevation in leads V2-V4. The nearest percutaneous coronary intervention (PCI) centre is 3.5 hours away by ground transport, and air transfer is not immediately available due to weather. What is the best reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy promptly in the rural hospital and transfer afterwards

Answer

Arrange transfer for primary PCI despite anticipated 3.5-hour delay

Answer

Give aspirin and clopidogrel only and arrange outpatient stress testing

Answer

Wait 6 hours to confirm the diagnosis before any reperfusion

Answer

Administer fibrinolytics only if the patient becomes haemodynamically unstable

Practice question