ABSTRACT
INTRODUCTION Several randomized trials and a pooled meta-analysis demonstrated the superiority of primary angioplasty as reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) (1), confirmed even when transfer is needed (2), that is mostly explained by the higher rate of TIMI 3 flow achieved with mechanical reperfusion. These data have encouraged clinicians to extend primary angioplasty to the vast majority of STEMI patients, with an increasing number of primary PCI procedures being observed in last years worldwide. However, due to logistics, outside of the setting of randomized trials, there is still a marked variability in management, including the modality of reperfusion therapy. In fact, primary angioplasty requires well-run regional networks that actually limit a timely application of the procedure to a minority of patients. Thus, currently, a larger proportion of mechanical recanalization would not certainly be a guarantee of optimal reperfusion.
