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EasyCardiologyST-elevation myocardial infarctionau-amcau-acem

A 62-year-old man presents to a small rural hospital 90 minutes after onset of central chest pain radiating to his left arm. ECG shows ST elevation in leads II, III and aVF. The hospital has no PCI capability; the nearest PCI centre is 4 hours away by road and retrieval is not immediately available. He has no contraindications to fibrinolysis. Observations are stable. What is the most appropriate immediate reperfusion strategy?

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