HardRural & Remote MedicineST-elevation myocardial infarction in a rural settingau-amcau-acemau-racp
A 55-year-old man presents to a rural emergency department 90 minutes after the onset of central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest PCI-capable centre is 5 hours away by road and 2 hours by air, and retrieval is delayed by bad weather. There are no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?