ST-Segment–Elevation Myocardial Infarction: Guidelines and the Challenge of Real-World Patient Care

ST-segment–elevation myocardial infarction (STEMI) is a serious condition that requires early, aggressive management to reduce infarction damage and the risk of mortality. Although evidence-based guidelines recognize the clear benefits of early, effective reperfusion in STEMI, a number of barriers interfere with prompt delivery of care. Delays in treatment that exceed current evidence-based recommendations often plague reperfusion with either fibrinolytic therapy or percutaneous coronary intervention (PCI). Treatment delays and STEMI outcomes have improved with the coordination of STEMI management by involving active participation from community-based emergency technicians, on-site emergency physicians, interventional cardiologists, nurses, ancillary PCI staff, and hospital administrators. Under investigation are new therapeutic strategies that take advantage of improved coordination of care, such as the administration of bolus fibrinolytic therapy in the prehospital environment followed by immediate transfer of the patient for PCI. This approach may shorten the time to effective reperfusion and improve outcomes. Ongoing studies will help in determining the role this facilitated-PCI strategy may play in effective management of STEMI.