Appropriate strategies for South Africa for the management of acute myocardial infarction in patients presenting with ST-segment elevation

Both patient and health-system delays contribute to delays inrestoring myocardial perfusion. Patient-related delays constitutethe time from onset of symptoms to the call for help, and onsetof symptoms to first medical contact. These will not be discussedhere. Of relevance are time metrics relating to ‘symptom onset toinitiation of fibrinolysis or first balloon or device, and hospitaldoor to either onset of fibrinolytic therapy (door-to-needle time)or to first balloon or device (door-to-balloon time)’, as well asstrategies that may be considered if circumstances are not ideal,as elegantly interrogated by Gershlick et al.