## Analysis of STEMI Acute Management ### Correct Statement Evaluation **Key Point:** Intravenous fibrinolytic therapy is NOT contraindicated in all STEMI patients. It remains a valid reperfusion strategy when primary PCI is not available or cannot be performed within the recommended time window. ### Fibrinolytic Therapy Indications **High-Yield:** Fibrinolytic therapy is indicated in STEMI when: - Primary PCI cannot be performed within 120 minutes of first medical contact - Symptom onset is within 12 hours (ideally within 3 hours for maximum benefit) - No contraindications exist ### Verified True Statements | Management Component | Status | Rationale | |---|---|---| | Dual antiplatelet therapy | **TRUE** | Aspirin + clopidogrel/ticagrelor/prasugrel reduce thrombotic events [cite:Harrison 21e Ch 297] | | Primary PCI within 120 min | **TRUE** | Preferred reperfusion strategy with superior outcomes vs fibrinolysis | | High-intensity statin | **TRUE** | Initiated acutely; reduces mortality and recurrent events | | Fibrinolysis contraindicated universally | **FALSE** | Contraindicated only in specific situations (active bleeding, recent surgery, etc.) | ### Clinical Pearl **Clinical Pearl:** The "door-to-balloon" time for primary PCI should be ≤90 minutes. If this cannot be achieved and symptom onset is <12 hours, fibrinolytic therapy is the appropriate alternative reperfusion strategy. ### Fibrinolytic Contraindications (Relative/Absolute) - Absolute: Active internal bleeding, recent intracranial event, intracranial neoplasm - Relative: Uncontrolled hypertension, recent major surgery, known bleeding disorder **Warning:** Do not confuse "fibrinolysis is not first-line" with "fibrinolysis is contraindicated." The former is true; the latter is false.
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