Question

A 67-year-old man with chest pain and inferior ST elevation on ECG presents to a rural emergency department without PCI capability, 45 minutes after symptom onset. The nearest PCI centre is 4 hours away by ground transfer. According to Canadian STEMI reperfusion recommendations, what is the best reperfusion strategy?

Accepted Answer

Immediate fibrinolysis in the rural hospital with planned transfer (pharmacoinvasive strategy)

Answer

Immediate primary PCI with transfer despite 4-hour delay

Answer

No reperfusion because he is older than 65 years

Answer

Thrombolysis only if pain persists beyond 6 hours

Answer

Treat with antiplatelets and anticoagulation only, no reperfusion

Practice question