A 62-year-old male with long-standing hypertension presents with crushing substernal chest pressure radiating to his left jaw. ECG reveals 3 mm ST-segment elevation in leads V1 through V4. What is the immediate definitive reperfusion therapy of choice?

Answer and explanation

Correct answer: B. Primary Percutaneous Coronary Intervention (PCI) within 90 minutes of medical contact

  1. Step 1: The patient has an acute anterior ST-segment elevation myocardial infarction (STEMI).
  2. Step 2: International cardiology guidelines (AHA/ACC and ESC) establish that primary PCI is the gold standard reperfusion modality when door-to-balloon time is under 90 minutes.
  3. Step 3: Fibrinolysis is indicated only when primary PCI cannot be performed within 120 minutes of first medical contact.
Answer
Primary Percutaneous Coronary Intervention (PCI) within 90 minutes of medical contact.
Why not the others: 'Intravenous thrombolysis with Tenecteplase' is second-line when timely PCI is unavailable; 'Urgent CABG' is reserved for multi-vessel failure or mechanical complications; 'Sublingual nitroglycerin and observation' fails to re-open the occluded LAD artery.

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