Primary percutaneous coronary intervention (PCI) is the most effective technique to treat acute myocardial infarction. Access to primary PCI is restricted in developing countries. Telemedicine greatly facilitates access of primary PCI to vast populations.

Primary percutaneous coronary intervention (PCI) has revolutionized the management of acute myocardial infarction (AMI). Although thrombolysis is still the mainstay of treatment in various parts of the world, primary PCI is vastly superior. Scientific guidelines maintain a class I indication for treating AMI with primary PCI if performed in a timely manner by an experienced provider.To mandate the urgency in performing primary PCI, parameters of door-to-balloon (D2B) times have been added. Short D2B times (<90 minutes) are desirable, although this recommendation is not universal. In developing countries, lack of infrastructure, insurance, facilities, and skilled providers greatly hamper the use of primary PCI. For example, in the entire continent of South America, less than 8% of the population has access to cardiac catheterization laboratories. In parts of Africa and some Asian countries, the situation is similarly abysmal. In these developing parts of the world, thrombolysis, often with Streptokinase, is still the predominant modality.

Other developing countries predominantly use a pharmaco-invasive approach. This strategy clearly has numerous advantages: a patient with AMI receives urgent thrombolysis and is then transported for possible PCI. In sharp contrast, in various developed countries, there is a comprehensive utilization of primary PCI for an entire population. These advanced countries use regional systems of care to optimize timeliness of re perfusion therapy. Pre hospital management is the norm and considerable reduction in morbidity and mortality has been achieved.The disparities of care between developed and developing countries for the management of AMI represent one of the largest global challenges in ST-elevation myocardial infarction (STEMI) interventions