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MediumCardiologyST-elevation myocardial infarctionca-mccqe1ca-rcpsc-emca-rcpsc-im

A 62-year-old man presents to a small rural emergency department 3 hours after sudden onset of crushing retrosternal chest pain radiating to his left arm. ECG shows 2-3 mm ST elevation in leads V2-V5. The nearest percutaneous coronary intervention (PCI) centre is 250 km away, with an anticipated first medical contact-to-balloon time of about 3 hours. Fibrinolysis can be started on site within 30 minutes. According to Canadian STEMI guidelines, what is the most appropriate reperfusion strategy?

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