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Anterior STEMI requiring reperfusion — ABEM Board MCQ

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ModerateCardiovascular emergenciesAnterior STEMI requiring reperfusionABEM Board

A 57-year-old man arrives as ESI 2 with chest pain for 4 hours. ECG shows ST elevation in V2-V5. The nearest PCI-capable hospital is 90 minutes away by transfer; no contraindications to fibrinolysis are present. Which of the following is the most appropriate next step in management?

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

Reveal the answer and explanation

Correct answer: D — Give fibrinolytic therapy if timely PCI cannot be achieved

For STEMI when timely PCI is not achievable and contraindications are absent, fibrinolysis is appropriate with transfer planning.

Reference: AHA/ACC STEMI guidance; ACEP Clinical Policy: Reperfusion Therapy for STEMI