A 58-year-old man has chest pain and ST elevation in leads II, III and aVF 90 minutes after onset. A PCI centre can deliver primary PCI within 100 minutes. What is the preferred reperfusion strategy?

Answer and explanation

Correct answer: A. Primary PCI, deliverable within 120 minutes of when fibrinolysis could be given

  1. Step 1: This is a STEMI, and reperfusion is time critical.
  2. Step 2: NICE advises primary PCI if it can be delivered within 120 minutes of when fibrinolysis could have been given; otherwise fibrinolysis.
Answer
Primary PCI, deliverable within 120 minutes of when fibrinolysis could be given.
Why not the others: Delay all treatment until the first troponin result is back from the laboratory: STEMI is diagnosed on ECG; waiting for troponin wastes myocardium. Medical therapy alone, with PCI offered electively after 48 hours of stabilisation: Medical therapy alone leaves an occluded artery for two days. Fibrinolysis at the local hospital: Fibrinolysis is the alternative when PCI cannot be achieved in time, which is not the case here.

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