Table 4 Summary of possible gaps and obstacles and the suggested actions needed to improve STEMI management in Egypt

Patients with high prevalence of risk factors

Primary prevention plan

Increased ischemic time and delayed presentation

Public awareness campaigns and patient education

Under use of EMS

Improving EMS service quantitatively and qualitatively

Under use of primary PCI

Increased health care expenditure

Increase number of PPCI centers

Establish STEMI networks and protocols

Extend medical insurance

Expand reimbursement to PPCI centers

Educate and train medical personnel

Streptokinase is still widely used

Replace it with TNK

Encourage out of hospital thrombolytic therapy

Encourage routine PCI post thrombolysis

Clopidogrel is widely used

Encourage more potent antiplatelets

High in-hospital mortality rate

Reduce the number of non-reperfused patients

Registries and quality control