{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T15:42:09Z","timestamp":1793720529728,"version":"4.6.1"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Suboptimal care for ST-elevation myocardial infarction (STEMI) in low- and middle-income countries is a significant problem. Registries from Latin America, Africa, and Asia show that &amp;lt;65% of patients receive reperfusion therapy, and widespread treatment delays and a lack of access to optimal therapies lead to preventable deaths and complications. While current guidelines provide a blueprint for care, their implementation in low-resource settings requires specific guidance that considers geographical, logistical, and economic realities. This clinical consensus offers a new framework for developing STEMI care systems in these countries. We propose a flexible, three-model pathway, based on the initiatives such as STEMI India and Stent \u2013 Save a Life. The models include a fibrinolysis model, a pharmaco-invasive strategy model, and a primary percutaneous coronary intervention (PCI) model. This approach emphasizes adaptability, allowing local STEMI systems to be tailored to specific circumstances. The framework also addresses specific, common challenges, such as delayed access to primary PCI, reperfusion in patients with cardiogenic shock and expected delayed PCI, fibrinolysis in patients with a high risk of bleeding, and the absence of fibrin-specific fibrinolytics, catheterization labs, or reperfusion therapies at all. The consensus also highlights the importance of continuous improvement, patient education, and adopting secondary prevention strategies. Ultimately, this framework is designed to help healthcare providers and leaders in developing countries improve their regional STEMI care systems.<\/jats:p>","DOI":"10.1093\/ehjacc\/zuaf114","type":"journal-article","created":{"date-parts":[[2025,9,3]],"date-time":"2025-09-03T11:41:08Z","timestamp":1756899668000},"page":"690-697","source":"Crossref","is-referenced-by-count":5,"title":["Reperfusion therapy for ST elevation myocardial infarction in low- to middle-income countries: a clinical consensus statement of the Association for Acute CardioVascular Care (ACVC), the European Association of Percutaneous Cardiovascular Interventions (EAPCI), the European Association of Preventive Cardiology (EAPC), the ESC Working Group on Thrombosis, and the Stent \u2013 Save a Life! Initiative"],"prefix":"10.1093","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3185-0051","authenticated-orcid":false,"given":"Diego","family":"Araiza-Garaygordobil","sequence":"first","affiliation":[{"name":"Unidad Coronaria, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez , Juan Badiano 1, Tlalpan, Ciudad de M\u00e9xico ,","place":["M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Alexander","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Kovai Medical Center and Hospital , Coimbatore ,","place":["India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kurt","family":"Huber","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Sigmund Freud University , Vienna ,","place":["Austria"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sigrun","family":"Halvorsen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Oslo University Hospital Ulleval , Oslo ,","place":["Norway"]},{"name":"Institute of Clinical Medicine, University of Oslo , Oslo ,","place":["Norway"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ingo","family":"Ahrens","sequence":"additional","affiliation":[{"name":"Cardiology and Medical Intensive Care, Augustinerinnen Hospital , Cologne ,","place":["Germany"]},{"name":"Faculty of Medicine, University of Freiburg , Freiburg ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Alviar","sequence":"additional","affiliation":[{"name":"The Leon H. Charney Division of Cardiology, New York University Grossman School of Medicine & Bellevue Hospital , New York, NY, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5942-4102","authenticated-orcid":false,"given":"Alexandra","family":"Arias-Mendoza","sequence":"additional","affiliation":[{"name":"Unidad Coronaria, Instituto Nacional de Cardiolog\u00eda Ignacio Ch\u00e1vez , Juan Badiano 1, Tlalpan, Ciudad de M\u00e9xico ,","place":["M\u00e9xico"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andre","family":"Dippenaar","sequence":"additional","affiliation":[{"name":"Royal Infirmary of Edinburgh and Edinburgh Medical School, University of Edinburgh , Edinburgh ,","place":["UK"]},{"name":"SA Endovascular, Cape Town, South African Heart Association , Johannesburg ,","place":["South Africa"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana 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