ABSTRACT
Primary percutaneous coronary intervention (PCI) is superior to fibrinolytic therapy as a reperfusion strategy in ST-elevation myocardial infarction (STEMI) when performed rapidly and by experienced operators. Compared with fibrinolytic therapy, primary PCI results in higher infarct artery patency rates and lower rates of reinfarction, stroke, and death (1). However, PCI programs are available in just 25% of acute-care hospitals in the United States and even fewer hospitals worldwide (2,3). As a result, only a minority of STEMI patients present directly to PCI hospitals and many receive care initially at local hospitals without cardiac catheterization laboratories. Clinicians at hospitals without PCI capability are left with two treatment options: immediate on-site fibrinolytic therapy or emergent interhospital transfer for primary PCI.
