In the setting of myocardial infarction, which circumstance would make IV streptokinase therapy most appropriate over angioplasty?

• A. MI within the past 12 hours
• B. Multiple-site MI
• C. Treatment with streptokinase within the past 30 days
• D. Uncomplicated inferior or posterior MI

Answer: (B)

When deciding reperfusion in a heart attack, the goal is rapid restoration of blood flow. If there are multiple simultaneous blockages (multiple-site MI), opening all affected arteries with catheter-based intervention can be time-consuming and technically challenging. IV streptokinase dissolves clots systemically, potentially restoring perfusion across several vessels more quickly than performing multiple angioplasty procedures. This makes thrombolysis the more practical choice in that situation, whereas recent streptokinase exposure would preclude its use, and simply timing or the location of the MI (inferior/posterior) doesn’t by itself favor thrombolysis over PCI when a catheter-based approach is available.