[Timing is crucial in acute myocardial infarction]

Thrombolytic agents and primary angioplasty (ACP) are two well defined methods for the treatment of patients with ST segment elevation myocardial infarction (STEMI). The use of both methods consecutively, called facilitated angioplasty, is a third alternative, that offers few advantages and is restricted to a small group of patients. The experience abroad demonstrated that ACP offers a higher reduction in mortality than thrombolysis. This is also the case in a national report published in this issue, showing that hospital mortality of patients treated with thrombolysis and ACP was 10.5% and 5.6%, respectively (p <0.01). The figures for long term mortality were 20.4% and 9.7%, respectively (p <0.01). The crucial factor to improve the treatment results in myocardial infarction in to reduce the time of total ischemia, from the onset of symptoms to the start of reperfusion therapy. Nowadays, the therapeutic challenges, besides improving percutaneous and pharmacological interventions, are to achieve an early consultation and to reduce institutional timing.