The patient in the vignette has an anterior myocardial infarction with ST-segment elevation. He was initially taken to a small community hospital that lacked interventional capabilities. Since he has no contraindication to fibrinolytic therapy, he could receive this therapy there or, alternatively, he could be transferred urgently for primary PCI. Because his symptoms have been present for more than 3 hours and he has high-risk features (i.e., tachycardia, rales, and anterior location of the infarction), we recommend his transfer for PCI, provided that the procedure can be performed in a timely fashion by an experienced operator in a high-volume catheterization laboratory. On the basis of the data available on facilitated PCI, we do not recommend administration of a fibrinolytic agent or glycoprotein IIb/IIIa inhibitor before the transfer.
(From: Primary PCI for Myocardial Infarction with ST-Segment Elevation by Ellen C. Keeley, M.D., and L. David Hillis, M.D. (NEJM: Volume 356:47-54 January 4, 2007):