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MediumCardiologyST-elevation myocardial infarctionca-mccqe1ca-rcpsc-emca-rcpsc-im

A 59-year-old man presents to a rural emergency department 60 minutes after the sudden onset of severe central chest pain radiating to his left arm, associated with diaphoresis and nausea. ECG shows 3 mm ST elevation in leads II, III and aVF with reciprocal changes in I and aVL. The nearest percutaneous coronary intervention (PCI) centre is 4 hours away by ground, and air transport is unavailable due to weather. What is the most appropriate reperfusion strategy?

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