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ST elevation myocardial infarction in a rural setting — RACP Adult Medicine MCQ

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ModerateCardiologyST elevation myocardial infarction in a rural settingRACP Adult Medicine

A 58-year-old man in a remote Western Australian clinic has crushing chest pain of 70 minutes duration. ECG shows 3 mm ST elevation in II, III and aVF. The nearest PCI-capable hospital is 4 hours away by road, and retrieval cannot arrive for 2 hours. Blood pressure is 128/76 mmHg and there is no contraindication to lysis. What is the most appropriate management?

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

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Correct answer: A — Give fibrinolysis immediately with antiplatelet and anticoagulant therapy, then arrange transfer

When timely PCI is unavailable, reperfusion should not be delayed and fibrinolysis is appropriate if there are no contraindications. Transfer remains necessary for rescue or early angiography. Waiting several hours for PCI, observing with troponins, or outpatient review would expose the patient to avoidable myocardial loss.

Reference: National Heart Foundation of Australia/CSANZ Australian ACS Guideline 2025