Optimizing US Prehospital Care of ST-Segment–Elevation Myocardial Infarction Because Time Is Life, Not Just Muscle

Time is muscle" in ST-segment elevation myocardial infarction (STEMI) is the foundational principle of STEMI care, but even more importantly, time is also life since mortality rises rapidly with delays beyond the "golden hour." 1 With the steep decline in in-hospital mortality for STEMI, the majority of deaths due to STEMI now occur out-ofhospital.Thus, the greatest opportunity for improving STEMI outcomes lies in reducing the interval between symptom onset and reperfusion of the thrombolytic occlusion, which can be achieved in some patients with a glycoprotein IIb/IIIa inhibitor or a thrombolytic agent, and in nearly all patients with percutaneous coronary intervention (PCI).Herein, we provide five recommendations for reducing this critical time interval, ranging from patient education to pre-hospital pharmaceuticals to changes in reimbursement for pre-hospital care teams (Figure 1).