Question

A 58-year-old man develops 90 minutes of severe central chest pain while working on a remote cattle station 250 km from the nearest PCI-capable hospital. ECG in the small local hospital shows 3 mm ST elevation in leads V2-V4. Road transfer to PCI would take 3.5 hours; aeromedical retrieval will not be available for at least 3 hours. What is the most appropriate reperfusion strategy?

Accepted Answer

Administer immediate fibrinolysis at the local hospital and arrange transfer after lysis

Answer

Wait for aeromedical retrieval and transfer for primary PCI without lysis

Answer

Arrange urgent road transfer for PCI without lysis

Answer

Give dual antiplatelet therapy and anticoagulation but no reperfusion therapy

Answer

Treat conservatively with analgesia and observation

Practice question