Question

A 65-year-old man presents to a small rural hospital 90 minutes after the onset of severe central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest PCI-capable centre is a 3-hour road transfer away and aeromedical retrieval will not arrive for at least 2 hours. He has no contraindications to thrombolysis. What is the most appropriate reperfusion strategy?

Accepted Answer

Give intravenous thrombolysis now and arrange transfer for possible rescue or routine angiography

Answer

Arrange immediate transfer to the PCI centre without giving thrombolysis

Answer

Delay reperfusion until aeromedical retrieval arrives so that primary PCI can be performed

Answer

Start intravenous unfractionated heparin and wait for pain resolution before deciding on reperfusion

Answer

Withhold reperfusion as symptoms have been present for less than 12 hours

Practice question