American Journal of Medical Quality XX(X) 1 –5 © 2011 by the American College of Medical Quality

Acute myocardial infarction (AMI) is a serious and potentially lethal condition for which percutaneous coro-nary intervention (PCI) has been found to be the most successful reperfusion therapy in reducing patient mortality and morbidity when administered promptly.1 Based on prior studies and recent evidence, the American College of Cardiology/American Heart Association (ACC/AHA) Task Force has identified key components to reduce mor-bidity and mortality including administration of aspirin and beta-blockers early on and at discharge, timely initia-tion of reperfusion, and smoking cessation counseling.2 However, although published studies have shown the positive effects of aspirin3 and beta-blockers,4 a gap remains between evidence-based AMI and actual care. Similarly, registries indicate that many patients present-ing with AMI are not treated promptly with reperfusion therapy, if at all.5 Studies show that the lack of prompt reperfusion is largely related to systemic barriers,1,6 although patient characteristics (ie, age, sex, race/ethnic-ity, insurance status, educational level, clinical character-istics7) also may contribute. Despite abundant research demonstrating the benefits of rapid reperfusion, many patients are not treated within the ACC/AHA recommended guideline of 90 minutes.5 Approximately 350 000 of the 1.1 million people diag-nosed with AMI every year in the United States die during the acute phase.2 The increased risk in mortality resulting from delays in door-to-balloon time has been modeled and even suggests reductions in time for those treated within 90 minutes.8 As a result, the Joint Commission and th