A 61-year-old man presents 90 minutes after chest pain onset with ST elevation in leads II, III, aVF. He is at a primary PCI-capable centre. Door-to-balloon time is currently estimated at 85 minutes. What is the most appropriate management?
- A Thrombolysis immediately since pain-to-door time exceeds 60 minutes
- B Fondaparinux and watchful waiting for 24 hours
- C Primary PCI if door-to-balloon time can be achieved within 90 minutes ✓
- D Primary PCI only if door-to-balloon time is under 60 minutes
Correct answer: C. Primary PCI if door-to-balloon time can be achieved within 90 minutes
Explanation
Current ACC/AHA and ESC guidelines recommend primary PCI for STEMI at a PCI-capable centre if door-to-balloon time can be achieved within 90 minutes of first medical contact. The 90-minute target (not 60 minutes) applies at PCI-capable centres. If the estimated time exceeds 120 minutes from first medical contact, pharmacoinvasive strategy (thrombolysis followed by PCI) is preferred. Fondaparinux alone is not appropriate for STEMI.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.