A 57-year-old presents to a non-PCI hospital 90 minutes after onset of anterior STEMI. There is no fibrinolysis contraindication. The earliest primary...

Question

A 57-year-old presents to a non-PCI hospital 90 minutes after onset of anterior STEMI. There is no fibrinolysis contraindication. The earliest primary PCI would occur 170 minutes after fibrinolysis could be started. What reperfusion plan best follows NICE guidance?

Accepted Answer

Give fibrinolysis plus an antithrombin and transfer immediately to a PCI centre

Answer

Give aspirin and observe for spontaneous ST resolution before deciding

Answer

Give unfractionated heparin alone and repeat the ECG after three hours

Answer

Delay reperfusion until troponin confirms myocardial necrosis

Answer

Transfer for primary PCI without fibrinolysis despite the predicted 170-minute delay

STEMI — MRCEM SBA MCQ

A 57-year-old presents to a non-PCI hospital 90 minutes after onset of anterior STEMI. There is no fibrinolysis contraindication. The earliest primary PCI would occur 170 minutes after fibrinolysis could be started. What reperfusion plan best follows NICE guidance?