Question

An adult with ST-elevation myocardial infarction arrives at a non-PCI hospital 45 minutes after symptom onset. The nearest PCI center is 140 minutes away by transfer. He has no contraindications to fibrinolysis. What is the best reperfusion strategy?

Accepted Answer

Administer fibrinolysis now (e.g., tenecteplase) and arrange transfer

Answer

Immediate transfer for primary PCI despite the delay

Answer

Give IV heparin and await transfer without fibrinolysis

Answer

Obtain CT angiography to exclude aortic dissection first in all cases

Answer

Start nitrates and observe for spontaneous reperfusion

Practice question

An adult with ST-elevation myocardial infarction arrives at a non-PCI hospital 45 minutes after symptom onset. The nearest PCI center is 140 minutes away by transfer. He has no contraindications to fibrinolysis. What is the best reperfusion strategy?