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MediumCardiologyST-elevation myocardial infarctionau-acemau-amc

A 68-year-old man presents to the emergency department of a small rural hospital 3 hours after onset of central chest pain radiating to his left arm, associated with diaphoresis and nausea. ECG shows 3 mm ST elevation in leads II, III and aVF. The nearest percutaneous coronary intervention (PCI) facility is 4 hours away by road and no retrieval aircraft is immediately available. What is the most appropriate reperfusion strategy?

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