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STEMI Rural Management — RACP Adult Medicine MCQ

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ModerateCardiologySTEMI Rural ManagementRACP Adult Medicine

A 58-year-old man presents 3 hours after onset of crushing chest pain. ECG shows 3 mm ST elevation in V1–V4 with reciprocal changes in II, III, aVF. He is at a non-PCI-capable rural hospital. Transfer time to the nearest PCI centre is estimated at 150 minutes. According to the 2025 Australian ACS guideline, what is the appropriate reperfusion strategy?

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

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Correct answer: D — Fibrinolysis with tenecteplase now, then transfer for angiography

The 2025 Australian ACS guideline recommends primary PCI if achievable within <90 minutes from first medical contact at non-PCI-capable centres. Since transfer time exceeds 90 minutes, fibrinolysis should be administered immediately (ideally within 30 minutes of presentation) followed by transfer for coronary angiography within 3–24 hours (pharmaco-invasive strategy). Tenecteplase is given as a single weight-based IV bolus.

Reference: NHF/CSANZ – 2025 – Australian Clinical Guideline for Diagnosing and Managing ACS