In a patient with ST-segment elevation myocardial infarction, what is the preferred reperfusion method when available?

• A. Fibrinolysis
• B. Pharmacologic treatment without intervention
• C. Percutaneous coronary intervention
• D. Coronary artery bypass graft surgery

Answer: (C)

In a STEMI, the goal is to restore blood flow to the affected artery as quickly as possible. The preferred reperfusion method when a capable facility is available is primary percutaneous coronary intervention (PCI). Mechanical reopening with PCI tends to reopen the blocked vessel more reliably, achieves higher rates of sustained reperfusion, and is associated with lower mortality and fewer bleeding complications compared with thrombolytic (fibrinolytic) therapy. It also allows immediate assessment and treatment of other coronary lesions and, if needed, prompt stent placement to keep the artery open.

If a PCI-capable center cannot achieve reperfusion within a recommended timeframe, fibrinolysis is used to achieve faster reperfusion, with plans to transfer for PCI when feasible (a pharmacoinvasive approach). Coronary artery bypass grafting is not the first-line reperfusion strategy in the acute STEMI setting; it’s reserved for cases where PCI is not possible or in complex, unsuitable anatomy or failed PCI.

So the best answer reflects that PCI, when readily available and timely, provides the most effective and durable reperfusion for STEMI.