In which situation is fibrinolysis the preferred reperfusion strategy over PCI for ST-elevation myocardial infarction?

Fibrinolysis is often preferred over percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) in specific scenarios where the patient presents later or when logistical challenges make PCI less effective. In the situation where symptoms began 6 hours ago with a transport time exceeding 2 hours, fibrinolysis becomes the more appropriate choice due to the extended time since symptom onset.

In STEMI management, there's a critical period during which myocardial tissue can be salvaged. If a significant delay in transport to a PCI-capable facility exists, the risk of irreversible myocardial damage increases. Fibrinolytic therapy can still be beneficial even several hours after symptom onset, especially in patients with persistent chest pain or ST elevation.

The option describes a patient who has waited longer than the ideal window for PCI but still within a timeframe where fibrinolytic therapy can reduce infarct size and improve outcomes. Because accessing PCI may take too long, and time is essential for myocardial protection, fibrinolysis is justified here.

This option highlights the importance of timely intervention and the practical considerations of transport times, which can influence the choice between these two reperfusion strategies.