A 58-year-old man presents to a small rural emergency department in northern Saskatchewan with 60 minutes of severe central chest pain and diaphoresis. ECG shows 3 mm ST elevation in leads V2-V4. The nearest PCI-capable centre is 250 km away, with an estimated first medical contact-to-device time of 150 minutes despite immediate transfer. Fibrinolysis (tenecteplase) can be given within 20 minutes. There are no contraindications to thrombolysis. What is the most appropriate reperfusion strategy?