Specialized centers and systems for heart attack care.

Evidence from randomized controlled clinical trials and registries suggest that primary percutaneous coronary intervention provides superior clinical outcomes when compared with fibrinolytic therapy for the treatment of ST segment elevation myocardial infarction (STEMI). However, the delivery of expert and timely primary percutaneous coronary intervention to the majority of patients with STEMI is extremely challenging. This objective has fueled the concept of regional centers of excellence for the care of patients with STEMI as well as regional STEMI networks similar to those currently available for trauma or stroke victims. This article reviews the rationale behind, as well as the issues inherent to, the development of systems of care for STEMI patients.