A rural hospital receives a 55-year-old woman with STEMI 40 minutes after symptom onset. Primary PCI cannot be performed within 120 minutes. Fibrinolysis is chosen. Within what maximum interval from the diagnosis should the fibrinolytic agent be administered to preserve its full benefit?

• A Within 10 minutes of diagnosis
• B Within 24 hours of diagnosis, benefit is unchanged
• C Within 90 minutes of diagnosis
• D Within 30 minutes of diagnosis ✓

Explanation

When timely PCI is unavailable, fibrinolysis should be given within 30 minutes of first medical contact or diagnosis, the door-to-needle target, and ideally within 3 hours of symptom onset where mortality reduction is greatest. Benefit falls steeply with delay because the salvageable myocardium and the thrombus susceptibility both decline over time. Ten minutes is not the recognized benchmark, and claiming unchanged benefit at 24 hours is incorrect since late lysis adds bleeding risk with little mortality gain.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.