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ModerateCardiologyST-elevation myocardial infarctionus-abimus-abemus-usmle-step-2us-usmle-step-3

A 62-year-old with anterior STEMI presents 45 minutes after chest pain onset to a rural ED without PCI capability; the nearest PCI centre is 150 minutes away by ground. ECG shows 3 mm ST elevations in V2-V4. Blood pressure 118/72 mmHg, no contraindications to fibrinolysis. What is the most appropriate immediate reperfusion strategy?

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