A patient with anterior STEMI is treated with thrombolytics as primary PCI was not available within 120 minutes. Pharmacoinvasive strategy is planned. According to current guidelines, at what window post-thrombolysis should routine coronary angiography be performed?
- A Within 2 hours (rescue PCI window)
- B 3–24 hours ✓
- C 48–72 hours
- D Only if re-infarction occurs
Correct answer: B. 3–24 hours
Explanation
Pharmacoinvasive strategy, validated by the STREAM trial and endorsed by current ESC and ACC/AHA guidelines, recommends routine coronary angiography 3–24 hours after successful thrombolysis. Transfer within 24 hours and catheterisation at 3–24 hours balances the risk of early catheterisation (lytic-induced coagulopathy) with the benefit of timely reperfusion assessment. Rescue PCI (within 2 hours) is reserved for failed thrombolysis (less than 50% ST resolution at 90 minutes). Waiting 48–72 hours or only acting on re-infarction delays care.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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