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Cardiovascular•Acute Coronary Syndromes

A 62-year-old man presents to the emergency department with central chest pain that started 90 minutes ago while watching television. He describes it as crushing and radiating to his left arm. He has a history of type 2 diabetes mellitus and smokes 20 cigarettes per day. His ECG shows 3 mm ST elevation in leads II, III and aVF. His blood pressure is 105/68 mmHg and heart rate is 56 bpm. Troponin is pending. The nearest primary PCI centre is 45 minutes away. What is the SINGLE most appropriate next step in management?

Administer thrombolysis with alteplaseStart dual antiplatelet therapy and admit for observationTransfer for primary percutaneous coronary interventionGive aspirin 300 mg and arrange routine cardiology reviewArrange an urgent outpatient stress echocardiogram

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