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MediumCardiologyST-elevation myocardial infarctionau-acemau-amc

A 59-year-old man presents to a small rural emergency department 90 minutes after onset of central crushing chest pain radiating to his left arm. ECG shows 3 mm ST elevation in leads V2-V5. Primary PCI is only available at a tertiary centre 4 hours away by road. There are no contraindications to fibrinolysis. What is the MOST appropriate reperfusion strategy?

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