This patient presents with an acute STEMI, evidenced by severe chest pain and ST elevation in leads V1-V4, indicating an anterior myocardial infarction. The most urgent management is to administer aspirin 300 mg immediately to inhibit platelet aggregation and reduce clot propagation. Simultaneously, arranging emergency primary percutaneous coronary intervention (PCI) is critical to restore coronary blood flow and limit myocardial damage. Early reperfusion therapy significantly improves survival and reduces complications. Other options like IV beta-blockers, nitroglycerin, or morphine are secondary and not priorities before revascularization.

Reference: Braunwald’s Heart Disease, Douglas L. Mann, Edition 12.