What is the preferred treatment strategy for a patient presenting to a PCI-capable facility with ST-segment elevation myocardial infarction (STEMI)?

The preferred treatment strategy for a patient presenting with ST-segment elevation myocardial infarction (STEMI) at a PCI-capable facility is to proceed with primary percutaneous coronary intervention (PCI) along with the administration of high-dose heparin and a loading dose of ticagrelor.

Primary PCI is the most effective method for restoring blood flow to the ischemic myocardium in STEMI patients. It is associated with improved clinical outcomes, including reduced mortality and lower rates of recurrent ischemia when compared to fibrinolytics or conservative management in appropriate patients. The immediate opening of the occluded coronary artery during PCI alleviates the myocardial ischemia effectively and quickly.

In conjunction with PCI, the use of high-dose heparin helps prevent further thrombus formation, which is crucial for ensuring the success of the intervention. Ticagrelor, as an antiplatelet agent, further supports the prevention of re-thrombosis at the site of the coronary intervention, thus enhancing the overall efficacy of the procedure. This dual approach of using anticoagulation and potent antiplatelet therapy maximizes the likelihood of a successful outcome following PCI.

Other options, such as conservative management, administering fibrinolytics alone, or utilizing an early