Effective Reperfusion for Acute Myocardial Infarction Begins with Effective Health Policy

“Time is muscle” is a cute but concise summary of two decades of research demonstrating the value of reperfusion therapy for patients with acute myocardial infarction and the importance of early initiation of treatment. On the basis of this research, the National Heart, Lung, and Blood Institute launched the National Heart Attack Alert Program in 1991. This program promotes the goal of treating acute myocardial infarction within 60 minutes of the onset of symptoms [1] and has helped many hospitals reduce the time between presentation and the initiation of thrombolytic therapy to less than 30 minutes. No evidence, however, suggests that the much longer interval between onset of symptoms and hospital presentation has changed.

To most physicians, the delay in hospital presentation seems far too long-and beyond their control. Most studies report that the median time from onset of symptoms to hospital presentation is between 2 and 6.5 hours [2-5]. The effect of public education campaigns …