MediumCardiologyST-elevation myocardial infarction in rural settingau-amcau-acem
A 28-year-old man presents to the emergency department with a 30-minute history of central chest pain radiating to his left arm, associated with diaphoresis and nausea. His ECG shows 3 mm ST elevation in leads V2-V4. He is in a small rural hospital with no on-site PCI. The nearest PCI centre is a 4-hour road transfer away and air retrieval is unavailable due to weather. What is the most appropriate reperfusion strategy?