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MediumCardiologyST-elevation myocardial infarctionau-amcau-racpau-acem

A 60-year-old man presents with central crushing chest pain for 45 minutes associated with diaphoresis and nausea. He lives in a rural town; the nearest PCI-capable centre is 3 hours away by road. ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal depression in aVL. Symptoms started 90 minutes ago. There are no contraindications to fibrinolysis. What is the most appropriate immediate reperfusion strategy?

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