A 62-year-old man presents with STEMI (anterior). Door-to-balloon time is currently 50 minutes. Cath lab is available in the hospital. Which reperfusion strategy is the standard of care per ACC/AHA guidelines?

• A Fibrinolytic therapy (tenecteplase) immediately, then transfer for angiography
• B Intra-aortic balloon pump insertion, then PCI
• C Pharmacoinvasive strategy regardless of door-to-balloon time
• D Primary percutaneous coronary intervention (PCI) within 90 minutes of first medical contact ✓

Explanation

ACC/AHA guidelines recommend primary PCI as the preferred reperfusion strategy for STEMI if it can be performed within 90 minutes of first medical contact (FMC-to-device time). This hospital can meet that target (door-to-balloon 50 min). Fibrinolysis is appropriate when primary PCI cannot be performed within 120 minutes of FMC. The pharmacoinvasive strategy (fibrinolysis + PCI 3-24 hours later) is reserved for situations where primary PCI is unavailable or delayed. IABP is not a reperfusion strategy.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.