STEMI — EECC MCQ

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

EasyCoronary Artery DiseaseSTEMIEECC

A 62-year-old man presents to the emergency department with acute central chest pain radiating to his left arm. His ECG shows 3 mm ST-segment elevation in leads V1-V4 with reciprocal changes in the inferior leads. High-sensitivity cardiac troponin T at presentation is 450 ng/L (normal <14 ng/L). He is haemodynamically stable with a blood pressure of 132/78 mmHg and heart rate of 88 bpm. First medical contact was 20 minutes ago. The nearest primary PCI centre is 45 minutes away by ambulance. What is the most appropriate immediate management?

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

Reveal the answer and explanation

Correct answer: B — Transfer directly for primary percutaneous coronary intervention

Explanation lettering: C = shown as A · E = shown as B · B = shown as C · A = shown as D · D = shown as E

Per the 2023 ESC ACS Guidelines, primary PCI is the recommended reperfusion strategy for STEMI if it can be performed within 120 minutes of first medical contact. The total transfer time here is approximately 45 minutes plus door-to-balloon time, well within the 120-minute window. Fibrinolysis (A) is only recommended when PPCI cannot be delivered within 120 minutes. Fondaparinux with delayed angiography (C) is inappropriate for STEMI. GPIIb/IIIa inhibitors (D) are not recommended as routine upstream therapy. Echocardiography (E) should not delay transfer for reperfusion. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: ESC (2023): Guidelines for the Management of Acute Coronary Syndromes: https://bnf.nice.org.uk/