Moving toward improved care for the patient with ST-elevation myocardial infarction: a mandate for systems of care.

Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for the patient with STelevation myocardial infarction (STEMI) regardless of whether they present to a PCI or non–PCI-capable hospital.2,3 These recommendations, based on randomized clinical trials and subsequent meta-analysis and meta-regression of these trials,4,5 are accompanied by a caveat: PCI must be performed in a timely manner. The unfortunate reality in the United States today is that many STEMI patients who are well suited for primary PCI do not receive PCI, or, when they do, it is frequently not within guideline-recommended time standards, a problem in particular for patients who present to hospitals without PCI capability.6