Coronary Artery Disease - STEMI Case #9

A 68-year-old male with a history of hypertension, diabetes and a prior stroke from an intracranial hemorrhage complains of 9/10 chest pain and shortness of breath. The pain radiates to his right arm and mid-epigastric area. He is diaphoretic as well. His temperature is 99.8, blood pressure 160/90 mm Hg, respirations 20 per minute, heart rate 70 beats per minute and oxygen normal on room air. Physical examination reveals an S4 heart sound and no murmurs. Chest X-ray is normal. His ECG is below:


The nearest facility that can perform percutaneous coronary intervention is 120 minutes away. Which of the following is the best option at this time?

A. Give fibrinolytic therapy along with standard medical therapy as a bridge to transfer to a PCI facility (facilitated PCI)

B. Give fibrinolytic therapy  along with standard medical therapy without plan for PCI depending on the patient’s response

C. Standard medical therapy only without fibrinolytics without transfer to a PCI facility

D. Standard medical therapy without fibrinolytics and then transfer the patient to a PCI facility