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Inferior STEMI — SCE Acute Medicine MCQ

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ModerateAcute Cardiac PresentationsInferior STEMISCE Acute Medicine

A 59-year-old man presents 70 minutes after crushing central chest pain began. ECG shows 2 mm ST elevation in II, III and aVF with reciprocal depression in I and aVL. Blood pressure is 102/66 mmHg and oxygen saturation is 96% on air. The nearest primary PCI centre can accept him immediately with expected wire crossing within 80 minutes. What is the most appropriate next step in management?

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

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Correct answer: C — Transfer immediately for primary PCI

This is an acute STEMI within the reperfusion window, and primary PCI is preferred when it can be delivered promptly. Fibrinolysis is a fallback when timely PCI is not achievable. Serial troponins are not needed to confirm a diagnostic STEMI ECG before reperfusion. The pearl is that reperfusion decisions are time-critical and ECG-driven.

Reference: NICE NG185; ESC STEMI guidance