A 62-year-old man is brought with 2-hour chest pain and ST elevation in leads II, III, aVF with reciprocal ST depression in I and aVL. Door-to-balloon time is projected to be 110 minutes. PCI laboratory is not immediately available. What is the preferred management strategy?

• A Medical management alone with anticoagulation
• B Primary PCI after transfer regardless of time delay
• C CABG on an emergency basis
• D Thrombolysis with tenecteplase followed by transfer to PCI centre ✓

Explanation

Current ESC 2023 and ACC/AHA STEMI guidelines recommend pharmacoinvasive strategy (thrombolysis followed by transfer for angiography within 3–24 hours) when primary PCI cannot be performed within 120 minutes of first medical contact. Tenecteplase is weight-adjusted and given as a single IV bolus. Medical management alone is inferior. Waiting for PCI beyond 120 minutes loses the time-dependent benefit. Emergency CABG is reserved for failed PCI or anatomical unsuitability.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.