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STEMI reperfusion decision — DIPIMC MCQ

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HardMedical EmergenciesSTEMI reperfusion decisionDIPIMCDipIMC

A patient has an ST-elevation myocardial infarction. You are in a rural area where the primary PCI centre is 2.5 hours away by road, and symptom onset was one hour ago.

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

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Correct answer: D — Deliver pre-hospital thrombolysis, as PCI cannot be achieved within the target time

Explanation lettering: D = shown as A · E = shown as B · B = shown as C · C = shown as D · A = shown as E

When primary PCI cannot be delivered within about 120 minutes of diagnosis, fibrinolysis should be given (pre-hospital where available) followed by transfer, because timely reperfusion is what limits infarct size. Insisting on PCI despite a long delay (A) sacrifices myocardium. Match the reperfusion strategy to the achievable time to treatment.

Reference: ESC/NICE STEMI guidance; JRCALC