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Anterior STEMI Primary PCI — RACP Adult Medicine MCQ

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EasyCardiologyAnterior STEMI Primary PCIRACP Adult Medicine

A 55-year-old man presents with 2 hours of central crushing chest pain radiating to the left arm. ECG shows ST elevation >2 mm in leads V1-V4 with reciprocal ST depression in II, III, aVF. Troponin is pending. He is haemodynamically stable. What is the most appropriate immediate management?

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Correct answer: A — Primary percutaneous coronary intervention (PCI) within 90 minutes

Anterior STEMI (ST elevation V1-V4 = LAD territory) within 12 hours requires primary PCI (door-to-balloon <90 minutes) as first-line reperfusion. While preparing for PCI: aspirin 300 mg, ticagrelor 180 mg or prasugrel 60 mg loading, unfractionated heparin, sublingual GTN, IV morphine if pain persists. If PCI cannot be achieved within 120 minutes of first medical contact, fibrinolysis (tenecteplase) should be given within 30 minutes.

Reference: CSANZ – 2025 – ACS Guidelines; ESC 2023 STEMI