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HardRural & Remote MedicineST elevation myocardial infarctionau-amcau-acemau-racp

A 59-year-old man presents to a small rural hospital 90 minutes after the onset of severe central chest pain. ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal ST depression in V1-V3. There is no access to percutaneous coronary intervention on site and transfer to the nearest PCI centre would take approximately 3 hours. He has no contraindications to thrombolysis. What is the most appropriate reperfusion strategy?

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