Manuel A. Pitta-Acevedo, Instituto Nacional Cardiovascular (INCOR), Lima, Perú
ST-segment elevation myocardial infarction (STEMI) requires early, effective, and organized reperfusion. International guidelines recommend primary percutaneous coronary intervention (PCI) when it can be performed within timely targets; however, this recommendation depends on integrated networks, efficient transport, territorial availability of PCI-capable centers, and early activation from first medical contact. In Peru, national registries have shown a persistent gap between guideline-based ideal time and real-world care pathways: fibrinolysis remains the most frequently used reperfusion therapy, timely primary PCI reaches only a limited proportion of patients, and a substantial percentage do not receive adequate reperfusion. This scenario should not be interpreted merely as poor guideline adherence, but as evidence that STEMI networks must be designed according to geography, resources, and real transfer times. A pharmacoinvasive strategy, defined as early fibrinolysis followed by systematic assessment of reperfusion, rescue PCI when indicated, and early coronary angiography after successful lysis, should play a central role where timely primary PCI cannot be reliably delivered. This review integrates Peruvian, Latin American, and international evidence, and proposes an operational STEMI network model adapted to the national context.
Keywords: ST-segment elevation myocardial infarction. Fibrinolysis. Pharmacoinvasive strategy. Primary angioplasty. STEMI networks. Peru.