Facharzt FMH Kardiologie Practice Questions - Facharzt FMH Für Kardiologie Spécialiste FMH En Cardiologie Exam

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A 58-year-old man presents to a regional non-PCI hospital with severe retrosternal chest pain for 45 minutes. The 12-lead ECG demonstrates 3 mm ST-segment elevation in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. The anticipated transfer time to the nearest catheterization laboratory is 110 minutes, with an estimated first medical contact (FMC)-to-wire crossing time of 135 minutes. According to current ESC STEMI guidelines, what is the most appropriate reperfusion strategy?

Administer weight-adjusted intravenous tenecteplase immediately within 10 minutes, followed by urgent transfer to a PCI center for routine post-fibrinolysis coronary angiography within 2 to 24 hours. Transfer the patient immediately for primary percutaneous coronary intervention without fibrinolysis, accepting the 135-minute delay since mechanical reperfusion is superior. Initiate an unfractionated heparin infusion and dual antiplatelet therapy, deferring reperfusion decisions until high-sensitivity troponin T results confirm acute myocardial necrosis. Administer intravenous eptifibatide monotherapy and arrange elective coronary angiography during the index hospitalization within 48 to 72 hours.

Correct Answer:

Administer weight-adjusted intravenous tenecteplase immediately within 10 minutes, followed by urgent transfer to a PCI center for routine post-fibrinolysis coronary angiography within 2 to 24 hours.

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