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MediumCardiologyST-elevation myocardial infarctionau-amcau-acem

A 58-year-old man presents to a small rural hospital 90 minutes after sudden onset central chest pain radiating to his left arm. He is diaphoretic and nauseated. ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal ST depression in I and aVL. The nearest PCI-capable centre is 3.5 hours away by road and retrieval is delayed. He has no contraindications to fibrinolysis. What is the most appropriate reperfusion strategy?

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