AMBOSS 200 High Yield (HY) Concepts For Step 2 Practice Test

If emergent PCI cannot be performed within 120 minutes in STEMI, what is the recommended alternative therapy?

Thrombolytic therapy Immediate PCI Start antibiotics Observation and analgesia

Correct Answer:

Thrombolytic therapy

Explanation:

In STEMI, restoring blood flow quickly is the priority. If primary PCI cannot be done within 120 minutes, the best alternative is thrombolytic (fibrinolytic) therapy to dissolve the clot and reperfuse the blocked coronary artery as soon as possible. Administer the fibrinolytic agent promptly (ideally within 30 minutes of arrival, with treatment ideally started within 12 hours of symptom onset) and then continue standard antiplatelet therapy while arranging transfer for further evaluation or rescue PCI if reperfusion is incomplete or fails. Be mindful of contraindications and the bleeding risk. Antibiotics or simply observing the patient would not address the occlusion.

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