Question

A 63-year-old man presents 45 minutes after onset of crushing central chest pain with diaphoresis. ECG shows 3 mm ST elevation in leads V2-V4. He is in a community hospital 60 minutes by ground from the nearest PCI-capable centre; transfer time plus door-to-balloon is estimated at 120 minutes. What is the best reperfusion strategy?

Accepted Answer

Immediate fibrinolysis in the current hospital, then transfer for angiography

Answer

Immediate primary PCI at the distant centre despite 120-minute delay

Answer

No reperfusion as symptom onset is less than 2 hours

Answer

Administer dual antiplatelet therapy only and arrange elective angiography

Answer

Observe for ECG evolution before deciding on reperfusion

Practice question