A 45-year-old man presents to the emergency department with sudden-onset central chest pain radiating to the left arm for 45 minutes. ECG shows 3 mm S...

Question

A 45-year-old man presents to the emergency department with sudden-onset central chest pain radiating to the left arm for 45 minutes. ECG shows 3 mm ST elevation in leads V2-V5. The nearest PCI-capable centre is 4 hours away by road; retrieval will take at least 2 hours. What is the most appropriate next step?

Accepted Answer

Administer aspirin and fibrinolytic therapy now, with transfer for rescue PCI if needed

Answer

Arrange immediate transfer for primary PCI without fibrinolysis

Answer

Administer aspirin, clopidogrel and commence heparin infusion only

Answer

Wait for repeat ECGs to confirm the diagnosis before thrombolysis

Answer

Give sublingual glyceryl trinitrate and discharge if pain settles

au-amc MCQ (SBA): STEMI reperfusion strategy