Cardioprotection Is a Delivery Problem: A First-Medical-Contact Framework for Acute Myocardial Infarction.

Dozens of agents that limit reperfusion injury preclinically have failed clinically. These failures are architectural, not biological: the right biology reaches the wrong place, as the wrong molecule, at the wrong time, judged by the wrong end point. We recast each as a design constraint and specify a staged regimen anchored at first medical contact.