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ST-elevation myocardial infarction — MCCQE Part 1 MCQ

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HardChest PainST-elevation myocardial infarctionMCCQE Part 1

A 64-year-old in a rural emergency department has an anterior STEMI 90 minutes after symptom onset. Expected first-medical-contact-to-device time is 170 minutes, but he had a spontaneous intracerebral haemorrhage three years ago. He has no shock or recurrent ventricular arrhythmia. Which reperfusion strategy is most appropriate?

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Correct answer: A — Transfer for primary PCI and give non-fibrinolytic antithrombotic therapy

Transfer for primary PCI and give non-fibrinolytic antithrombotic therapy: The STEMI still requires reperfusion, but the prior intracranial haemorrhage removes fibrinolysis from the pharmacoinvasive pathway and makes immediate PCI transfer the safest available strategy. Give tenecteplase now and transfer only if ST elevation persists at 90 minutes: Persistent ST elevation is a rescue-PCI criterion only after eligible fibrinolysis; this patient should not receive a fibrinolytic agent. Give tenecteplase now and transfer immediately for routine early angiography: Routine transfer after lysis is appropriate for an eligible patient, but the previous intracranial haemorrhage makes tenecteplase unsafe. Use antithrombotic therapy and arrange angiography after twenty-four hours: Medical treatment alone leaves an occluded artery untreated and should not replace the fastest feasible mechanical reperfusion. Obtain serial troponin results prior to initiating the interhospital transfer: Troponin confirmation is unnecessary when the ECG already establishes STEMI and would add avoidable ischaemic delay.

Reference: https://caic-acci.org/wp-content/uploads/2020/03/2019-STEMI-Guidelines.pdf