Optimizing outcomes in patients with STEMI: mortality, bleeding, door-to-balloon times, and guidelines: the approach to regional systems for STEMI care: defining the ideal approach to reperfusion therapy based on recent trials

Achieving rapid reperfusion is an essential step in the management of ST-elevation myocardial infarction (STEMI). Although primary percutaneous coronary intervention (PCI) is the preferred option, alternative strategies, and in particular intravenous fibrinolysis, especially as part of a pharmaco-invasive approach (i.e. followed by rapid coronary angiography with PCI when necessary) offer a reasonable alternative, when practical considerations make the performance of timely primary PCI impossible. Concomitant antithrombotic treatment is essential to grant optimal clinical results. This includes both antiplatelet and anticoagulant medications, with the aim to improve efficacy, without notably increasing bleeding complications, which are strong predictors of poor immediate and long-term outcomes. From a practical standpoint, network organization is central for optimizing patient care at the acute stage of MI. This review describes current approaches used to optimize outcomes in STEMI patients and their results in different systems of care.