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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Successful treatment of myocardial infarction &#40;MI&#41; is one of the major achievements in cardiovascular disease management in recent decades&#46; Internationally this favorable outcome was mainly obtained through national primary percutaneous coronary intervention &#40;P-PCI&#41; programs available 24&#47;7&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">In Portugal&#44; this organizational challenge was addressed in 2007 with specific regulatory documents<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> aimed at pre-hospital emergency system management for MI and stroke and procedures for referral to emergency departments and catheterization laboratories &#40;the coronary and stroke fast-track systems&#41;&#46; In 2010&#44; P-PCI was officially defined as the priority strategy&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> A national network of P-PCI facilities was set up in 2015<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> with hubs covering more than 95&#37; of the overall resident population&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The latest available national data<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a> showed an impressive 25&#37; reduction in standardized overall MI-related mortality over a one-decade period &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Figure 1</a>&#41;&#46; This reduction was more marked in female patients aged over 70 years&#44; who are conventionally considered to be an under-treated group&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">In this period&#44; a significant increase was noted in the numbers of nationwide P-PCI procedures&#44; along with a corresponding decrease in patients treated by fibrinolysis &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Figure 2</a>&#41;&#46; However&#44; this growth has become less steep in the last few years&#44; which warrants further analysis&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">These results were obtained through the convergence of official regulatory initiatives regarding the pre-hospital emergency services &#40;INEM&#41; and hospital institutions with programs promoted by medical societies&#44; such as the Stent for Life initiative of the European Society of Cardiology&#44; endorsed by the Portuguese Society of Cardiology&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The work published by Pereira et al&#46; in this issue of the <span class="elsevierStyleItalic">Journal</span><a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> summarizes the differences between parameters in ST-segment myocardial infarction patients in 2011 and 2016 and reveals a significant improvement in MI treatment pathways&#44; as shown by a consistent reduction in patient-related time delays&#46; As the authors point out&#44; a similar improvement was not recorded in system delays&#44; emphasizing the need to maintain and strengthen these initiatives&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Another important finding concerns improvements in access to appropriate therapy&#44; with a significant reduction in admissions to non-PCI capable centers along with increased activation of the pre-hospital emergency system by use of the 112 emergency telephone number&#46; These improvements have had major repercussions in system performance&#44; considering the chronic difficulties related to secondary patient transportation between different hospital institutions&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The importance of public health gains obtained with adequate treatment of MI &#40;one of the leading causes of death in Portugal as well as in other European countries&#41; highlights the need for more complete data collection at a national level&#44; for example enabling monitoring of system and institutional performance&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">The quantitative aspects of this question must be complemented with qualitative information regarding&#44; for example&#44; geographical inequalities and location-specific limitations to access&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The complete lack of information regarding non-revascularized patients and the real reasons for their status should also be addressed&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">In recent years&#44; several initiatives have been promoted designed to lead to the establishment of a national MI registry&#44; in various circumstances and with different official interlocutors&#46; We consider such a registry to be an essential tool to support strategic decisions based on real-word data that are sometimes very different from those expected&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">This registry would overcome one of the most important current limitations&#58; matching clinical data from the pre-hospital emergency system with hospital information and subsequent prognostic assessments&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Although this goal has yet to be attained&#44; we note some recent hopeful developments&#44; including an increasing awareness of the importance of this information&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare&#46;</p></span></span>"
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