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MediumCardiologyST-elevation myocardial infarction reperfusion strategyca-mccqe1ca-rcpsc-emca-rcpsc-im

A 59-year-old man presents to a rural emergency department 60 minutes after sudden-onset crushing central chest pain radiating to his left arm. ECG shows 3 mm ST elevation in leads V2-V4 with reciprocal changes. There is no contraindication to reperfusion. The nearest PCI-capable centre is 3 hours away by road. What is the most appropriate next step?

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