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HardCardiologyST-elevation myocardial infarctionca-mccqe1ca-rcpsc-em

A 58-year-old man presents to a rural emergency department with 90 minutes of crushing central chest pain and 3 mm ST elevation in leads II, III, and aVF. The nearest PCI-capable centre is 3 hours away by ground and 2.5 hours by air, assuming immediate transfer. According to Canadian STEMI reperfusion guidance, what is the most appropriate reperfusion strategy?

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