TEC Cardiologia Practice Questions - TEC - Título De Especialista Em Cardiologia (Sociedade Brasileira De Cardiologia AMB) Exam

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A 58-year-old man presents to an emergency department in a community hospital without percutaneous coronary intervention (PCI) capabilities experiencing 90 minutes of severe retrosternal crushing chest pain radiating to his left jaw. The 12-lead electrocardiogram (ECG) reveals 3.5 mm ST-segment elevation in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. The estimated transfer time to the nearest tertiary hemodynamics center for primary PCI is 150 minutes. According to the Diretriz da Sociedade Brasileira de Cardiologia sobre Tratamento do Infarto Agudo do Miocárdio com Supradesnivelamento do Segmento ST (SBC STEMI Guidelines), which reperfusion strategy is most appropriate?

Immediate transfer for primary PCI regardless of transfer delay, since mechanical reperfusion is always superior to pharmacologic fibrinolysis. Immediate administration of a fibrin-specific fibrinolytic agent (such as Tenecteplase or Alteplase) followed by routine transfer to a PCI-capable center for coronary angiography within 2 to 24 hours (pharmacoinvasive strategy). Immediate administration of full-dose intravenous unfractionated heparin and dual antiplatelet therapy while awaiting emergency transfer for rescue PCI only if clinical symptoms persist. Initiation of intravenous nitroglycerin and beta-blocker therapy with delayed elective coronary angiography scheduled during the hospitalization index.

Correct Answer:

Immediate administration of a fibrin-specific fibrinolytic agent (such as Tenecteplase or Alteplase) followed by routine transfer to a PCI-capable center for coronary angiography within 2 to 24 hours (pharmacoinvasive strategy).

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