As Dr Zacarías emphasizes, the data reveal a reality that leaves us with a bittersweet taste. On the one hand, we see high rates of reperfusion and, on the other, high mortality rates. When we take a closer look and realize how long it takes to seek medical care, we feel responsible for the lack of health promotion regarding acute myocardial infarction, as cardiovascular causes are the leading cause of death in Argentina, as evidenced by the vital statistics reports from the Ministry of Health. (1) Moreover, this is largely preventable if risk factors are managed appropriately, and when it does occur, mortality should be lower compared to other countries. (2) National publication records indicate that since 2008, mortality has not fallen below 8%. (3) But then, what does the high reperfusion rate tell us? It does not appear that the healthcare system has a problem with resources (we are, of course, speaking in general terms, as there are situations where resources are scarce), nor with the concept, since patients do undergo reperfusion. So why is mortality so high? The answer could lie in the failure to meet operational targets that have an impact on the total duration of ischemia. And how can we address the situation? The hospital door is a useful point at which to divide the problem into two parts. From the door outward, we must promote the early recognition of chest pain and warning signs. Inside the hospital, we must optimize our organization to receive patients and perform proper triage. Every institution should also be part of a myocardial infarction care network to effectively manage resources. Low-complexity centers should be aware of their support centers, which, in turn, should be aware of their role within the network to avoid delays, particularly within a fragmented healthcare system such as the one in Argentina. As we have previously mentioned, the ARGEN-IAM-ST is not the only registry showing these data, as they are available in previous studies and vital statistics from the Ministry of Health: from different angles, with the same results. One activity that could prove constructive at conferences is to discuss, in addition to mortality in myocardial infarction, potential solutions to the consultation and care process, such as the feasibility of implementing artificial intelligence to enhance triage in the emergency department, the use of data to improve the logistics of patient transfers, and coordination with cardiac catheterization laboratories, etc. (4)

Finally, it is important to mention the long-term costs for heart attack survivors. The total duration of ischemia accounts for not only mortality, but also in- and out-of-hospital complications. Although the ARGEN IAM-ST registry does not report on the latter, these complications are well known and generate a significant burden of healthcare costs due to left ventricular dysfunction, which, depending on its severity, leads to specific treatments for heart failure, the implantation of expensive devices and, in the longer term, the need for a heart transplant n some cases - all of which are preventable and avoidable. (5)