PPCI within 120 minutes of FMC (90 min for early presenters <2hrs from symptoms onset), is the gold standard in the management of STEMI. However, access to PPCI reperfusion procedures is limited for much of the world’s population. This is not only due to timely transfer concerns (see figure below), but is also related to other factors such as socio-economic status and country-specific healthcare practices and policies.2

Non-patient-related factors that influence timely reperfusion

Graphic showing various non patient related factors influencing timely reperfusion

In developing countries, such as India, door-to-balloon (DTB) times are prolonged, with one study reporting an average delay to PPCI of 260 minutes (range: 185 min to 390 min).3


  1. Armstrong PW & Van de Werf F. No STEMI Left Behind. JAPI 2014;62:469-470.
  2. Victor SM, et al. A Prospective, Observational, Multicenter Study Comparing Tenecteplase Faciliated PCI Versus Primary PCI in Indian Patients with STEMI (STEPP-AMI) [Abstract]. J Am Coll Cardiol 2014;63(12, Suppl S):S4.