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HardCardiologyST-elevation myocardial infarctionca-mccqe1ca-rcpsc-emca-rcpsc-im

A 59-year-old man presents to a small rural hospital in northern Canada 60 minutes after onset of crushing central chest pain with radiation to the left arm and associated diaphoresis. ECG shows 3 mm ST elevation in leads V2-V4. The nearest percutaneous coronary intervention (PCI) centre is 4 hours away by ground and 2.5 hours away by air, with no immediate air transport available. What is the best reperfusion strategy?

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