Question

A 58-year-old man presents to a rural emergency department 60 minutes after onset of severe central chest pain. ECG shows 3 mm ST elevation in leads V2-V4. The nearest percutaneous coronary intervention (PCI) centre is 250 km away, and transport time is estimated at 3 hours. A helicopter is unavailable due to weather. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolysis immediately and arrange transfer to a PCI centre after thrombolysis

Answer

Transfer directly for primary PCI without fibrinolysis despite an estimated 3-hour delay

Answer

Provide antiplatelets and anticoagulation only and observe for spontaneous reperfusion

Answer

Delay any reperfusion until weather improves sufficiently for helicopter transfer

Answer

Administer half-dose fibrinolysis only and no further reperfusion

Practice question