A 68-year-old woman presents with 2 hours of severe chest pain and ST elevation in V1 to V4. She has a history of a hemorrhagic stroke 4 months ago. Primary PCI is not available within 120 minutes. Which is the most appropriate reperfusion strategy?
- A Streptokinase
- B Tenecteplase
- C Primary PCI regardless of delay ✓
- D Conservative management with antiplatelets only
Correct answer: C. Primary PCI regardless of delay
Explanation
A history of hemorrhagic stroke within the past year is an absolute contraindication to thrombolytic therapy due to the high risk of intracranial hemorrhage. Since thrombolysis is contraindicated, the patient must undergo primary PCI regardless of the delay, as the benefit of reperfusion outweighs the risk of bleeding.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.