What is the preferred reperfusion strategy for STEMI when it is available within 90 minutes?

• A. Thrombolytics within 30 minutes
• B. PCI in less than 90 minutes
• C. Observation only
• D. Beta-blocker therapy only

Answer: (B)

When a STEMI patient has access to a catheterization lab within 90 minutes of first medical contact, the preferred reperfusion strategy is urgent primary PCI (immediate balloon angioplasty with possible stent placement). This approach mechanically reopens the blocked coronary artery, yielding higher success in restoring blood flow, better preservation of heart muscle, and lower mortality and complication rates compared with clot-busting drugs. The emphasis on a door-to-balloon time of 90 minutes or less reflects the goal of restoring perfusion as quickly as possible to minimize infarct size. If PCI cannot be performed within this window, thrombolytic therapy becomes the alternative, but it carries more bleeding risk and generally less favorable outcomes than prompt PCI. Observation or beta-blocker therapy alone do not reperfuse the blocked vessel and are not appropriate as sole strategies in STEMI.