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MediumCardiologyST-elevation myocardial infarctionau-amcau-racpau-acem

A 63-year-old man presents to a small rural emergency department 90 minutes after onset of severe central chest pain radiating to his left arm. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest PCI-capable centre is 4 hours away by road and there is no retrieval service available in the next 2 hours. What is the most appropriate immediate management?

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