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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 90 minutes after onset of crushing central chest pain. ECG shows 3 mm ST elevation in leads V2-V4, consistent with an anterior STEMI. The nearest percutaneous coronary intervention (PCI) centre is a 3-hour ground transfer away, and no air transport is available for at least 2 hours. Fibrinolytic drugs are immediately available. What is the most appropriate reperfusion strategy?

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