“Time is muscle” in reperfusing occluded coronary arteries in acute myocardial infarction

There is still room for improvement, both in decreasing delays in, and deciding who is eligible for, reperfusion therapy

In patients with acute ST-segment-elevation myocardial infarction (STEMI), early coronary reperfusion — within 1 to 2 hours of symptom onset — by either thrombolysis or primary percutaneous coronary intervention (PCI) reduces the mortality rate by half. However, this benefit quickly dissipates with further delay in treatment.1 As “time is muscle”, it is the time from symptom onset to reperfusion (or total ischaemic time), rather than the mode of reperfusion, that is the critical determinant of outcome. Hence the imperative to minimise: (i) delay by patients in recognising symptoms as possible myocardial infarction (MI) and seeking medical help; (ii) delay in ambulances responding to calls; (iii) delays in diagnosing STEMI on first medical contact; and (iv) omissions or delays in administering the most appropriate means of reperfusion in eligible patients. In this issue of the Journal, Huynh and colleagues, using data from a prospective Australian registry, report on processes of care and outcomes of 755 patients presenting with suspected STEMI.2