STEMI Diagnosis and Management

A 58-year-old man with a 10-year history of hypertension and type 2 diabetes presents to the emergency department with acute-onset crushing substernal chest pain radiating to the left arm, associated with diaphoresis and nausea for the past 2 hours. On examination, blood pressure is 145/92 mmHg, heart rate 102/min, and respiratory rate 20/min. A 12-lead ECG shows ST-segment elevation of 3 mm in leads II, III, and aVF, with reciprocal ST depression in leads I and aVL. Troponin I is 0.8 ng/mL (normal <0.04). The patient is on aspirin 75 mg daily at home. What is the most appropriate immediate management?

A 52-year-old woman with no prior cardiac history presents to the emergency department with acute-onset severe anterior chest pain and diaphoresis for 90 minutes. She is a current smoker and takes oral contraceptives. On examination, blood pressure is 110/70 mmHg, heart rate 88/min. A 12-lead ECG obtained at 15 minutes shows ST-segment elevation of 2.5 mm in leads V1–V4 with reciprocal ST depression in leads II, III, and aVF. High-sensitivity troponin is 0.05 ng/mL (upper limit of normal 0.04). The nearest PCI-capable hospital is 180 km away with an estimated transport time of 3 hours. What is the most appropriate reperfusion strategy?

What is the maximum recommended door-to-balloon time for primary percutaneous coronary intervention (PCI) in STEMI?

A 58-year-old man with diabetes and hypertension presents to the emergency department with acute anterior wall ST-elevation myocardial infarction (STEMI) of 2 hours duration. He is hemodynamically stable with no contraindications to fibrinolysis. The hospital does not have PCI capability and transfer to a PCI-capable centre will take 90 minutes. What is the drug of choice for immediate reperfusion therapy?

A 52-year-old man with acute inferior wall STEMI undergoes successful primary percutaneous coronary intervention (PCI) with stent placement. At the end of the procedure, he is started on dual antiplatelet therapy. Which of the following is the drug of choice for long-term P2Y12 inhibition in this patient?