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CLINICAL STATEMENTS AND GUIDELINES

April 1, 2025 Circulation. 2025;151:e771–e862. DOI: 10.1161/CIR.0000000000001309 e802

reperfusion and increased survival in STEMI in several pre- versus postimplementation comparison studies throughout the world.1–6 Over the past 15 years, considerable gains have been made in reducing FMC to reperfusion times in patients with STEMI and these improvements in reperfusion times have been associated with improved outcomes.5,7 Unfortunately, recent declines have been reported in the rates of achieving established STEMI performance measures,8 in part due to the COVID-19

Figure 6. Care System Pathway for Patients Experiencing Ischemic Symptoms Suggestive of ACS. Systems of STEMI care, and the most common routes by which patients present for diagnosis and definitive reperfusion therapy for STEMI. Best clinical practice consists of patients calling 9-1-1 (or other emergency services) to activate EMS; EMS obtaining a prehospital ECG, activating the cardiac catheterization laboratory from the field for suspected STEMIs, and transporting the patient to the nearest PCI center when possible; and achieving a system goal of FMC-to-device time within 90 minutes. Colors correspond to Class of Recommendation in Table 2. *Patients with chest tightness or other symptoms indicative of a heart attack. ACS indicates acute coronary syndromes; ED, emergency department; EMS, emergency medical services; FMC, first medical contact; PCI, percutaneous coronary intervention; PPCI, primary percutaneous coronary intervention; and STEMI, ST-segment elevation myocardial infarction.

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