The objective was to analyze the pre-hospital pharmaco-invasive therapy strategy of the public health service in the western region of Paraná. This is a retrospective study based on data from the State Health Department (SESA-Pr) from December 2020 to November 2023. The mean age of the patients was 62 years (+/- 12.5), 62% were male, and 53.3% showed ST-segment resolution. The median time from diagnosis to thrombolysis was 119 minutes. Rescue catheterization was required in 29 (31.5%) patients. There were 8 (8.7%) deaths recorded within 30 days and 11 (12%) within 1 year. The low rate of ST-segment resolution, observed in only 53.3% of patients, was likely due to delays in the system, as 68.5% of patients received thrombolytics more than 90 minutes after diagnosis. It was concluded that the current model does not meet guideline recommendations and has room for improvement. It was recommended that SESA-PR change its strategy to extend pre-hospital fibrinolysis to Emergency Care Units (UPAs) and Small Hospitals, expanding the care network and reducing treatment delays.