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EasyCardiologyST-elevation myocardial infarctionau-amcau-racpau-acem

A 60-year-old man presents to a small rural emergency department 90 minutes after the onset of severe central chest pain radiating to his left arm. His ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal ST depression in V1-V3. The nearest percutaneous coronary intervention (PCI) centre is 250 km away, with an expected transfer time of 3 hours. His blood pressure is 135/80 mmHg and there are no contraindications to fibrinolysis. He has just received 300 mg aspirin orally. What is the most appropriate next step in management?

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