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MediumIndigenous HealthSTEMI in rural/remote settingca-mccqe1ca-rcpsc-emca-rcpsc-im

A 59-year-old man with chest pain presents to a remote northern nursing station. ECG shows a clear inferior STEMI. The nearest PCI-capable hospital is 500 km away and not reachable within 2 hours; helicopter transfer will take approximately 4 hours from first medical contact. Fibrinolytic therapy can be given within 30 minutes. According to Canadian STEMI guidance adapted to rural and remote settings, what is the best reperfusion strategy?

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