For STEMI, what is the preferred reperfusion strategy and its time targets?

• A. Thrombolysis within 30 minutes of hospital arrival; PCI if necessary
• B. Primary PCI within 60 minutes; if unavailable, emergency surgery
• C. Primary PCI within 90 minutes of first medical contact; if unavailable, thrombolysis within 30 minutes of hospital arrival (with contraindications considered)
• D. PCI within 24 hours with no thrombolysis option

Answer: (C)

Restoring blood flow quickly is the priority in STEMI. The best approach is primary PCI, performed as soon as possible, with a target of within 90 minutes from the first medical contact to the balloon in the cath lab. If PCI cannot be done within that window, thrombolytic therapy should be given promptly, ideally within 30 minutes of hospital arrival (door-to-needle time), after evaluating for contraindications because bleeding risks must be carefully weighed. This plan reflects that PCI offers the most effective and durable reperfusion when timely, but thrombolysis serves as a critical fallback when PCI isn’t available quickly enough.