It's a matter of time: contemporary pre-hospital management of acute ST elevation myocardial infarction.

S ubstantial intellectual and financial resources have been invested in the quest to reduce outcomes in patients with ST elevation myocardial infarction (STEMI) through improved pharmacological and mechanical reperfusion therapies. By contrast, little emphasis has been placed on enhancing the medical systems whereby these treatments are delivered, especially as it relates to pre-hospital reperfusion. In this article we will review (1) the importance of timely reperfusion, (2) data supporting pre-hospital fibrinolysis, and (3) a novel contemporary systems based approach to improving outcomes in patients with acute cardiac events.