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STEMI with delayed PCI — RCPSC EM MCQ

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HardCardiovascular emergenciesSTEMI with delayed PCIRCPSC EM

A 58-year-old man is brought to a rural ED as CTAS 2 with 70 minutes of crushing chest pain. BP is 142/88, HR 96, SpO2 97%, and ECG shows 3 mm ST elevation in II, III and aVF with reciprocal anterior depression. The nearest PCI centre cannot accept transfer for more than 150 minutes. He has no bleeding history or recent stroke. What is the most appropriate next step?

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

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Correct answer: C — Give fibrinolysis with antiplatelet and anticoagulant therapy, then arrange transfer for angiography

This is an inferior STEMI within the reperfusion window where timely primary PCI is unavailable; fibrinolysis with adjunct antithrombotic therapy followed by transfer is appropriate when contraindications are absent.

Reference: Canadian Cardiovascular Society/CAIC STEMI guideline; Emergency Care BC STEMI fibrinolysis summary