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HardCardiologyAcute ST-elevation myocardial infarctionca-mccqe1ca-rcpsc-emca-rcpsc-im

A 59-year-old man presents to a small rural emergency department 45 minutes after onset of severe central chest pain. ECG shows 3 mm ST elevation in leads V2-V4. The nearest percutaneous coronary intervention centre is 3 hours away by ground and 90 minutes away by helicopter, which is currently grounded due to weather. What is the most appropriate reperfusion strategy?

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