Optimizing STEMI Care Pathways: The Critical Role Of EMS In Early Cath Lab Activation And Outcome Improvement

Abstract

Timely reperfusion remains the cornerstone of care for patients presenting with ST-elevation myocardial infarction (STEMI). Delays in reperfusion therapy are strongly associated with increased morbidity and mortality, underscoring the importance of streamlined care pathways. Emergency Medical Services (EMS) serve as the first point of contact for most STEMI patients, positioning them as a critical link in the chain of survival. This review explores the evolving role of EMS in activating the cardiac catheterization (cath) laboratory, reducing door-to-balloon (D2B) times, and ultimately improving patient outcomes. Evidence from international studies highlights the effectiveness of EMS-initiated cath lab activation protocols, pre-hospital electrocardiogram (ECG) transmission, and direct transport to percutaneous coronary intervention (PCI)-capable centers. Furthermore, we examine system-level strategies, including multidisciplinary collaboration, standardized STEMI alert systems, and integration of telemedicine, which support EMS-driven processes. Ethical, logistical, and training considerations are also discussed, along with technological innovations such as AI-assisted ECG interpretation. By synthesizing current literature, this article underscores the central role of EMS in optimizing STEMI care pathways and provides recommendations for practice and policy aimed at enhancing patient survival and functional recovery.