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Transfer for primary angioplasty: who and how?

Randomised trials have led to the conclusion that percutaneous coronary intervention (PCI) is the best reperfusion strategy for most patients with acute myocardial infarction (AMI). However, these trials have limited application to routine practice. Modern trials of mechanical reperfusion strategies need to take account of logistics, transfer times, and adjunctive drug treatment during transfer (facilitated PCI). Such PCI protocols need to be judged against very early thrombolysis with modern agents. This has been the thrust behind a series of recent studies addressing these “real world” issues in early AMI management