Summary

It has been well established that primary percutaneous coronary intervention (PCI) is superior to fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI) but only if coronary reperfusion can be established in a timely manner (<90 minutes) by skilled operators. Achieving that goal has been a challenge, however, because of delays in diagnosis as well as in treatment. Two particular areas of concern are the effective use of prehospital electrocardiograms and the appropriate treatment strategy for patients who must be transferred a long distance for PCI.