In a STEMI within 10 hours where PCI capability is not available, which reperfusion therapy is most appropriate?

• A. Observation
• B. Thrombin inhibitors
• C. Fibrinolysis
• D. PCI

Answer: (C)

Restoring blood flow quickly in STEMI is the priority. If primary PCI cannot be done promptly, giving a fibrinolytic agent to achieve reperfusion is the best option within the 10-hour window. Thrombolysis dissolves the clot and can restore coronary flow faster when PCI isn’t available, which reduces infarct size and improves outcomes compared with no reperfusion. PCI would be ideal, but it isn’t available in this scenario, so pharmacologic reperfusion is the appropriate choice.

Observing without reperfusion would miss the chance to limit damage, and thrombin inhibitors don’t provide rapid reperfusion—they anticoagulate but don’t dissolve the clot. After fibrinolysis, a plan for subsequent angiography/PCI may be considered if feasible.