"How could I convince my interventionalist to come do a cath in the middle of the night?"

I just received this email today.  I receive these fairly frequently:Dear Dr. Smith:I am an Emergency physician working in an outlying hospital in _________. We have an interventional hospital to which we refer cath lab patients.  I had a 31 year old with typical chest pain and vomiting and the attached ECG. I was sure he was infarcting but couldn’t convince the interventionalist to take him (after emailing him the ECG).I treated the patient aggressively with medical management and transfered him to the tertiary center.  They did not take him to the cath lab emergently.  When he went to the cath lab the next morning he had a 99% proximal LAD lesion and a massive troponin rise.I found the experience a little frustrating and was wondering if there was any specific ECG criteria or feature that I could have used to convince the cardiologist to get out of his bed at midnight.Thanks for your help on this.Kind regards,Dr. _________Here is the ECG:There is minimal ST depression at the J-point in lead V3, and much more in V4-V6.  In precordial leads, there should be some J-point elevation, especially in a young male (that is why the guidelines for STEMI require more than 2.5 mm for a male under age 40, although this is not very sensitive).There is a hyperacute T-wave in aVL, with reciprocal ST depression in II, III, aVF.--This ECG is diagnostic of severe ischemia.--Precordial T-waves are similar to de Winter's T-waves, but not quite as large. --(de Win...
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