Question

A 58-year-old man presents to a small rural hospital 90 minutes after onset of crushing central chest pain. ECG shows 3 mm ST elevation in leads V2-V4. The nearest PCI-capable centre is 250 km away and cannot achieve balloon inflation within 120 minutes of first medical contact. There are no contraindications to fibrinolysis. According to Canadian STEMI guidance, what is the best reperfusion strategy?

Accepted Answer

Administer fibrinolysis with a fibrin-specific agent in the rural hospital and plan early PCI

Answer

Arrange immediate transfer for primary PCI despite expected total delay of 3 hours

Answer

Treat with aspirin only and observe for ECG resolution

Answer

Administer low-molecular-weight heparin and delay invasive therapy until the next day

Answer

Arrange elective PCI within 72 hours without fibrinolysis

Practice question