Regional systems of care for patients with ST-elevation myocardial infarction: being at the right place at the right time.

ST-segment–elevation myocardial infarction (STEMI) presents a true medical emergency, where the relationship between treatment (reperfusion) and mortality is measured in minutes. Fortunately, when administered early in properly selected patients, both fibrinolytic therapy and primary percutaneous coronary intervention (PCI) have been associated with significant reductions in mortality.1,2 Unfortunately, it has become increasingly clear that only a minority of STEMI patients receive fibrinolytic therapy within 30 minutes from door-to-needle or receive primary PCI within 90 minutes from door-to-balloon as recommended by the guidelines from the American College of Cardiology/American Heart Association (AHA).3