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

A 60-year-old man presents to a rural emergency department 90 minutes after onset of crushing central chest pain. ECG shows 3 mm ST elevation in V2-V4. The nearest percutaneous coronary intervention (PCI) centre is 3 hours away by ground despite optimal transfer. What is the most appropriate reperfusion strategy?

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