Reperfusion therapy starts in the ambulance.

Reperfusion therapy for ST-elevation acute coronary syndromes aims at early and complete recanalization of the infarct-related artery in order to salvage myocardium and improve both early and late clinical outcomes. The benefit rises exponentially the earlier therapy is initiated. The highest number of lives saved is within the first hour after symptom onset: the “golden hour.” The exponential form of the curve relating mortality to time-to-reperfusion has major implications for the timing of treatment. The impact of delay in time-to-treatment lessens as the duration of ischemia lengthens. Consequently, reducing delays will have a much more positive return in patients presenting early for those presenting late. These considerations have provided a strong incentive for the initiation of very early reperfusion therapy.