In a patient with STEMI presenting within two hours of chest pain, what is the preferred reperfusion strategy when a PCI-capable cath lab can perform primary PCI within 90 minutes of first medical contact?

• A. Emergent primary PCI is preferred; if PCI cannot be performed within 120 minutes, administer fibrinolytic therapy.
• B. Fibrinolytic therapy should be administered immediately regardless of PCI availability.
• C. Medical therapy alone with antiplatelets and statins is sufficient.
• D. Delay reperfusion until after transfer to another facility

Answer: (A)

Rapid reperfusion is essential in STEMI to minimize myocardial damage. When a PCI-capable cath lab can perform primary PCI within 90 minutes of first medical contact, primary PCI is the preferred reperfusion strategy because it provides the highest likelihood of restoring blood flow with the best survival and lower bleeding risk compared to thrombolysis. Fibrinolytic therapy is reserved for situations where PCI cannot be performed within about 120 minutes. Medical therapy alone does not reperfuse the occluded vessel, and delaying reperfusion by transferring care or waiting for other arrangements worsens outcomes.