Time is myocardium and time is outcomes.

As an interventional cardiologist and a clinical trialist, I am often asked, “what do we need to do to improve mortality by another 1% in the setting of acute myocardial infarction?” Indeed, nearly a decade and a half of effort and many hundreds of millions of dollars have been spent in pursuit of this elusive “1% reduction” in mortality by both the pharmaceutical and the device industry. As the report by the Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT 2) investigators in the present issue of Circulation highlights,1 this kind of advance may not be achieved exclusively with new drugs or devices, but in also reducing time to treatment and in modifying patient behavior to seek these potentially life-saving treatments earlier.