Question

A 61-year-old man presents to a small rural emergency department in northern Ontario with 90 minutes of central chest pain and anterior ST-elevation myocardial infarction on ECG. The nearest PCI-capable centre is 260 km away by ground; estimated door-to-balloon time would be 3.5 hours. There are no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolysis immediately, then transfer for rescue or facilitated PCI

Answer

Immediate transfer for primary PCI without fibrinolysis

Answer

Give aspirin only and arrange outpatient stress testing

Answer

Admit locally and observe for resolution of ST-elevation without reperfusion

Answer

Give fibrinolysis only and do not transfer if symptoms improve

Practice question