Question 1 of 182
A 58-year-old man presents to a rural emergency department with 40 minutes of crushing substernal chest pain radiating to the left arm, diaphoresis, and nausea. He is a smoker with hypertension. Blood pressure is 148/90 mm Hg, heart rate 92/min. ECG shows 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in I and aVL. The nearest percutaneous coronary intervention (PCI)-capable center is 3 hours away by ground transport, and no helicopter is available. He has no contraindications to thrombolysis. Aspirin has been given. Which of the following is the most appropriate next step in reperfusion?