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In the past few years, the prognosis of patients with acute myocardial infarction has greatly improved largely because more and more patients are being treated with primary angioplasty.1,2 Although the first publication on the superiority of primary coronary angioplasty [percutaneous coronary intervention (PCI)] over thrombolysis was in 1993, daily practice only started changing from the moment both the American and European guidelines recommended primary angioplasty as first-line therapy 10 years later. However, to implement the new guideline of providing timely primary angioplasty to every patient with ST elevation myocardial infarction (STEMI) is not so easy. It can be done in two different ways: either you extend the number of centres performing primary PCI or you improve your regional organization regarding inter-hospital transfer. Both options have been shown to decrease time to treatment.3 However, a badly organized inter-hospital transfer system alone should not be the motivation for non-PCI centres to start performing PCI themselves. Many did not trust the first reports on improvement of door-to-balloon times with the organization of a regional network. Often physicians argued that this … *Corresponding author. Tel: +31 384242198, Fax: +31 384243222, Email: v.r.c.derks{at}isala.nl

The challenge of reducing time to reperfusion in patients with acute ST elevation myocardial infarction