Question

A 58-year-old man presents to a small rural hospital in northern Ontario with 90 minutes of crushing central chest pain and diaphoresis. ECG shows 3 mm ST elevation in leads V2-V4. The nearest PCI-capable centre is 250 km away by road and the estimated door-in-door-out plus transfer time is 3.5 hours. There are no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy immediately, then transfer to the PCI centre for pharmacoinvasive management

Answer

Immediate transfer to the PCI centre without fibrinolysis

Answer

Give dual antiplatelet therapy and arrange elective angiography within a week

Answer

Administer fibrinolytic therapy and keep him at the rural hospital without transfer

Answer

Start intravenous heparin and observe for spontaneous reperfusion without reperfusion therapy

Practice question