This presentation will focus upon the impact of early reperfusion on infarct size and outcomes with the emphasis on a systems approach in communities which do not have a PCI-capable catheterization laboratory and consequently rely on rapid transport to a referral hospital with the requisite facilities. The advantages and disadvantages of thrombolysis followed by transport (the drip and ship or pharmacoinvasive approach) will be discussed as will be the barriers to optimizing this therapeutic strategy.

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