In STEMI, what is the preferred reperfusion strategy if PCI can be performed within 90 minutes?

• A. Emergent primary PCI
• B. Thrombolytic therapy
• C. Coronary bypass grafting
• D. Medical therapy alone

Answer: (D)

The main idea is rapid reperfusion of the blocked coronary artery in an ST-elevation MI. When PCI can be performed within about 90 minutes, emergent primary PCI is the preferred reperfusion strategy because it most reliably restores blood flow to the affected area, minimizes infarct size, and improves survival and functional outcomes compared with other approaches. Thrombolytic therapy, while an option when PCI isn’t available promptly, carries bleeding risks and is generally less effective at achieving complete and durable reperfusion. Medical therapy alone does not reopen the occluded artery and thus cannot prevent ongoing myocardial damage in a STEMI. Coronary bypass grafting is not the first-line reperfusion strategy in the acute setting; it’s reserved for situations where PCI is not feasible or has failed. Therefore, when timely PCI is possible, emergent primary PCI is the best approach.