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HardCardiologyST-elevation myocardial infarctionca-mccqe1ca-rcpsc-em

A 60-year-old man presents to a rural emergency department 90 minutes after sudden onset of chest pain and ST-elevation myocardial infarction (STEMI) on ECG. The nearest PCI-capable centre is 4 hours away by ground, and air transfer is unavailable due to weather. According to Canadian STEMI systems of care principles, what is the best reperfusion strategy?

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