Question

A 62-year-old man presents to a rural emergency department 60 minutes after onset of crushing central chest pain and anterior ST-elevation myocardial infarction. Primary PCI is 3.5 hours away by ground, no rapid air transfer is available. What is the best reperfusion strategy?

Accepted Answer

Administer fibrinolytic therapy immediately, then arrange transfer

Answer

Arrange transfer for primary PCI only, no fibrinolysis

Answer

Start dual antiplatelet therapy and anticoagulation without reperfusion

Answer

Administer fibrinolytic therapy only if he deteriorates haemodynamically

Answer

Wait for serial ECGs to confirm before treating

Practice question

A 62-year-old man presents to a rural emergency department 60 minutes after onset of crushing central chest pain and anterior ST-elevation myocardial infarction. Primary PCI is 3.5 hours away by ground, no rapid air transfer is available. What is the best reperfusion strategy?