The publication of the analysis by Castillo Costa et al. from the ARGEN-IAM-ST registry is a key tool for identifying opportunities for improvement and growth. (1) Documenting that 7.5% of patients with ST-segment elevation myocardial infarction (STEMI) are admitted after cardiac arrest (CA)—approximately one in thirteen cases—is essential for understanding the complexity of this condition.

However, to interpret this data correctly, we must consider selection bias. The registry captures information from centers affiliated with the Argentine Society of Cardiology (SAC) and the Argentine Federation of Cardiology (FAC), both institutions with an academic profile. In terms of volume, the registry included an average of 682 patients per year. When this data is compared with the estimated national incidence for a population of 46 million inhabitants—between 18 000 and 22 000 STEMI cases per year according to Western epidemiological standards—it becomes clear that only a fraction of the national reality is being captured. This is relevant data because, if mortality in the shock and cardiac arrest subgroup reaches 71% in the most complex centers, it is worth asking what happens in the remaining cases.

From the interventional cardiology perspective, the unfavorable course of these cases despite an adequate overall reperfusion rate (85% in the group with CA) suggests that simply opening the culprit artery is insufficient in the setting of hemodynamic collapse. In high-complexity centers in other countries, the use of advanced mechanical circulatory support (MCS) has begun to improve outcomes in this scenario. The DanGer Shock trial demonstrated that microaxial pump support (Impella) reduced mortality in cardiogenic shock to 45.8% versus 58.5% with standard therapy; a substantial difference compared with our setting, where intra-aortic balloon pump is often the only available resource, if any. (2) However, large-scale implementation of these measures is complex and entails considerable costs for the health system.

Therefore, an initial focus within our healthcare system should be to ensure that all patients receive a reperfusion rate comparable to those reported in this registry as early as possible. To achieve results similar to those reported in registries such as those of the European Society of Cardiology (ESC), (3) with reperfusion rates above 90%, or the SWEDEHEART registry, where primary percutaneous coronary intervention exceeds 90%, (4) it is imperative to further expand initiative such as Stent-Save a Life!. (5) This involves strengthening myocardial infarction reperfusion networks and the door-to-balloon programs but above all prioritizing the pharmaco-invasive strategy as an effective and equivalent alternative in our setting. In cases of ambulance transfers with prolonged delays or unpredictable logistics that threaten optimal reperfusion times, early thrombolysis should be considered a clinical priority, ensuring early arterial patency and reducing total ischemia time.

This registry and its analysis represent important tools to improve patient outcomes in our setting and constitute a step toward transforming fragmented care networks into a system that prioritizes reperfusion and early referral to high-complexity centers.