skip to main content

Fibrinolysis vs Primary PCI Decision — EECC MCQ

Instant feedback + full explanation. One question, done properly.

ModerateCoronary Artery DiseaseFibrinolysis vs Primary PCI DecisionEECC

A 58-year-old man presents with an acute inferior STEMI. He arrives at a non-PCI-capable hospital. The estimated transfer time to the nearest PCI centre is 150 minutes. What is the recommended reperfusion strategy?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — If the expected delay from first medical contact to PCI wire crossing exceeds 120 minutes, fibrinolysis should be administered within 10 minutes (ideally pre-hospital) followed by transfer for rescue PCI if reperfusion fails, or routine angiography within 2-24 hours if fibrinolysis is successful

The 2023 ESC ACS Guidelines maintain a clear algorithm for STEMI reperfusion: primary PCI is the preferred strategy if achievable within 120 minutes of first medical contact (FMC-to-wire crossing). If this target cannot be met, fibrinolysis should be administered within 10 minutes of STEMI diagnosis (pre-hospital if possible). After fibrinolysis: (1) if successful (>50% ST resolution at 60-90 minutes) — transfer for routine angiography within 2-24 hours (the STREAM trial approach); (2) if failed — urgent rescue PCI. Fibrinolytic agents used: tenecteplase (preferred — weight-adjusted single IV bolus), alteplase, or reteplase. Adjunctive therapy: aspirin, clopidogrel (not ticagrelor/prasugrel with fibrinolysis), and enoxaparin or UFH. Half-dose tenecteplase for patients ≥75 years.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes