A district hospital receives a 55-year-old man 50 minutes after onset of ST elevation myocardial infarction. Primary PCI is not available and transfer would take more than 120 minutes. Fibrinolysis is planned. Within what time window from hospital arrival should the fibrinolytic agent ideally be administered?

• A Within 10 minutes of arrival
• B Within 30 minutes of arrival ✓
• C Within 60 minutes of arrival
• D Within 90 minutes of arrival

Explanation

When primary PCI cannot be performed within 120 minutes of first medical contact, fibrinolysis should be given, with a door-to-needle target of 30 minutes. The corresponding benchmark for primary PCI is a door-to-balloon time of 90 minutes or less. Mortality benefit of fibrinolysis is greatest within the first hour of symptom onset and declines steeply thereafter, so delays beyond 30 minutes erode the advantage of early reperfusion.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.