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MediumEmergencySTEMI reperfusion in remote settingca-mccqe1ca-rcpsc-em

A 65-year-old man presents 1 hour after sudden onset of crushing chest pain. ECG shows ST elevation in V1-V4. The nearest PCI-capable centre is 4 hours away by ground and air transport is not available. What is the most appropriate reperfusion strategy?

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