Nephrology (CKD, glomerular diseases) — MCQs

A 67-year-old man with a history of hypertension and type 2 diabetes presents to the emergency department with 2 hours of substernal chest pressure radiating to his left arm, diaphoresis, and nausea. BP is 98/60 mmHg, HR 112 bpm, RR 22/min, SpO₂ 94% on room air. A 12-lead ECG is obtained showing ST elevations in leads V1–V4 with reciprocal ST depressions in leads II, III, and aVF, consistent with an anterior STEMI. The nearest PCI-capable center is 140 minutes away by transfer, and the anticipated first-medical-contact-to-device time will exceed 120 minutes. Which of the following is the most appropriate next step in management?