Fibrinolysis in STEMI is indicated when PCI cannot be performed within which timeframe?

• A. Cannot receive PCI within 120 minutes
• B. PCI within 60 min
• C. PCI within 30 min
• D. After 24 hours

Answer: (A)

In STEMI, the fastest way to restore blood flow is crucial. Primary PCI is preferred when it can be done promptly, but if PCI cannot be performed within a limited time window, fibrinolysis is used to achieve reperfusion as soon as possible. The key threshold used in guidelines is about 120 minutes (2 hours) from first medical contact to PCI. If PCI cannot be performed within 120 minutes, fibrinolysis should be given promptly (ideally within 12 hours of symptom onset, with door-to-needle time as short as possible, usually ≤30 minutes). Therefore, the correct idea is that fibrinolysis is indicated when PCI cannot be performed within 120 minutes.

The other timeframes do not align with this standard: PCI is considered feasible within those shorter windows, so fibrinolysis wouldn’t be indicated there, and waiting beyond 24 hours falls outside the reperfusion window where such therapy is beneficial.