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HardCardiologyST-elevation myocardial infarction reperfusion strategyca-mccqe1ca-rcpsc-emca-rcpsc-im

A 58-year-old man presents with a 2-hour history of crushing central chest pain radiating to his left arm. The rural emergency department has no percutaneous coronary intervention facility; the nearest PCI centre is 4 hours away by road with no air transport available due to weather. ECG shows 3 mm ST elevation in leads V2-V4. What is the best reperfusion strategy according to Canadian STEMI recommendations?

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