Correspondence Letter by Weiss and Gotsman Regarding Article, “Evolution From Fibrinolytic Therapy to a Fibrinolytic Strategy for Patients With ST-Segment–Elevation Myocardial Infarction” To the Editor: We read with great interest the editorial by Dr Bates on the implications of the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial,1 but we suggest taking another small step forward and returning to the strategy we introduced 30 years ago2 (that has somehow been forgotten): prehospital thrombolysis for a subset of patients with ST-segment–elevation myocardial infarction (STEMI) with short ischemic time. Reimer and Jennings3 gave a dramatic description of the rapid progression of the wave front of cell death in STEMI, which becomes transmural and nearly complete within 3 to 4 hours of coronary artery occlusion. This description inspired us to start prehospital thrombolysis, the only effective way to achieve early reperfusion, thus preserving myocardium and left ventricular function and preventing heart failure.2,4 The great rush from thrombolysis to primary percutaneous coronary intervention was justified because it achieves more complete revascularization but unfortunately is usually impossible to perform within the narrow time window of myocardial salvage. This was reinvestigated by Francone et al,5 who, using cardiac magnetic resonance, showed that salvage was markedly reduced when reperfusion occurs after >90 minutes of coronary occlusion. The mean time from pain onset to primary percutaneous coronary intervention in all STEMI trials and registries is 3 hours, and this has not been reduced until now. The measurement of door-to-balloon time is inadequate because the ischemic time from pain onset to arterial reperfusion determines infarct size. Yes, mortality is reduced by primary percutaneous coronary intervention, but the infarct is still large and later heart failure is still a major unsolved problem. We suggest the use of prompt prehospital thrombolysis in a subset of STEMI patients who have a large volume of myocardium at risk and a short ischemic time of