A 63-year-old man attends a rural emergency department with crushing chest pain for 45 minutes. ECG shows clear ST elevation in the anterior leads. Th...

Question

A 63-year-old man attends a rural emergency department with crushing chest pain for 45 minutes. ECG shows clear ST elevation in the anterior leads. The nearest PCI-capable centre is 3.5 hours away even with air transfer. According to STEMI systems of care guidance, what is the most appropriate reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy immediately in the rural ED and arrange transfer to a PCI centre afterwards

Answer

Arrange immediate transfer for primary PCI even though first medical contact-to-balloon time will be >3 hours

Answer

Treat with aspirin only and review when transfer is available

Answer

Delay fibrinolysis until cardiology telephone review several hours later

Answer

Start beta-blockers only and arrange outpatient cardiology follow-up

ca-mccqe1 MCQ (SBA): STEMI management in rural settings