Survival after myocardial infarction depends not only on reperfusion but on continuity of follow-up, medication adherence, rehabilitation and psychosocial support. In remote regions, geography disrupts each stage of this pathway. Using Prespes in northwestern Greece as an illustrative case, this perspective examines how long travel distances, absence of local percutaneous coronary intervention capability, successive transfers, limited specialist access and weak continuity of care affect acute and long-term outcomes. Existing local practices, including informal ECG sharing, telemedicine infrastructure and mobile health services, are described, highlighting their limited integration into routine care. A tiered implementation framework is proposed, distinguishing measures feasible with current resources, interventions requiring regional coordination and reforms dependent on national policy. Priorities include formal STEMI networks, simplified clinical pathways, protected early follow-up, telecardiology, supported use of patient-owned devices, specialist outreach, treatment simplification and improved access to rehabilitation. The objective is equitable evidence-based cardiovascular care regardless of place of residence.