A 58-year-old man in a rural northern community presents with chest pain consistent with ST-elevation myocardial infarction (STEMI). The nearest percu...

Question

A 58-year-old man in a rural northern community presents with chest pain consistent with ST-elevation myocardial infarction (STEMI). The nearest percutaneous coronary intervention (PCI) centre is 4 hours away by ground and 2 hours away by air, depending on weather. According to Canadian STEMI management principles, what is the best reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy promptly at the local hospital and arrange transfer to a PCI centre after lysis

Answer

Transfer for primary PCI even though first medical contact-to-balloon time will likely exceed 2 hours and no fibrinolysis is given

Answer

Withhold reperfusion because transfer times are long

Answer

Give aspirin only and observe for spontaneous reperfusion

Answer

Wait for daylight to transfer safely before initiating any therapy

ca-mccqe1 MCQ (SBA): ST-elevation myocardial infarction in rural settings