Coronary Artery Disease USMLE Step 1 Practice Question
A 48-year-old man with a 10-year history of hypertension and hyperlipidemia presents to the emergency department with acute substernal chest pain that began 90 minutes ago. The pain is severe (9/10), radiating to his left arm and jaw, and is associated with diaphoresis. His wife reports he has never had similar symptoms. Vital signs: BP 168/98 mmHg, HR 108 bpm, RR 20, SpO2 96% on room air. On examination, he appears anxious and diaphoretic. An EKG obtained within 10 minutes of arrival demonstrates 3-mm ST elevation in leads V2, V3, and V4 with reciprocal ST depression in leads II, III, and aVF. Serum troponin I is 2.9 ng/mL (normal <0.04). He receives aspirin 325 mg and unfractionated heparin 80 U/kg bolus. Emergent cardiac catheterization reveals a completely occluded left anterior descending coronary artery with TIMI 0 flow. Which of the following interventions has been demonstrated to provide the greatest reduction in short-term and long-term mortality in this clinical scenario?
Answer choices
- APrimary percutaneous coronary intervention with stent placementCorrect answer
- BImmediate high-dose intravenous nitroglycerin infusion
- CImmediate high-intensity statin loading followed by beta-blocker initiation
- DIntra-aortic balloon pump placement prior to coronary angiography
- EImmediate initiation of dual antiplatelet therapy with clopidogrel and observation for 24 hours
- FFibrinolytic therapy with alteplase within the catheterization laboratory
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