Would you have given thrombolytics to this NSTEMI patient?

Case submitted by Dr. James AlvaA middle aged male called EMS for chest pain. EMS arrived and confirmed that the patient was complaining of chest pain and shortness of breath.They recorded this prehospital ECG:What do you think?Normal QRS complex rhythm with hyperacute T-waves in V2-V6, I and aVL. Slight STE in V2 only, with significant STD and thus de-Winter pattern in V4-V6. Leads II and III show reciprocal depression of the ST segment (II) and T-wave (III). This is diagnostic of acute myocardial infarction of the anterolateral walls, with the most likely etiology being Occlusion of the LAD. In other words, this ECG shows LAD OMI.Why was ST depression excluded from thrombolytics in all the guidelines? (except in the American 2013 guidelines, in which it is indicated for 1) STD in V1-V4 of posterior MI and 2) widespread STD with STE in aVR.The data:The data on when to give thrombolytics is incredibly scant. All trials of thrombolytics vs. placebo had poorly defined ECG criteria for enrollment.  Those that required ST Elevation had no instructions in the methods of how to measure ST Elevation.  No study analyzed ECGs to determine subgroups that benefit except to classify as STE, STD, or T-wave inversion.  Only ISIS-2, GISSI-1, LATE, and TIMI IIIB enrolled patients with ST depression.  They enrolled those with as little as 1 mm of ST depression in only 1 lead.  There were small numbers of patients.  Very few were enrolled in less that 6 hours...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs