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The scientific ‘battle’ (for the optimal reperfusion therapy in acute myocardial infarction) between pharmaco-oriented and balloon-oriented cardiologists has already lasted 16 years. Tarantini et al. ,1 in a meta-analysis, have suggested a sophisticated mathematical equation to calculate the acceptable primary percutaneous coronary intervention (p-PCI)-related delay [(compared with thrombolysis (TL)] for individual patients presenting with acute ST-segment elevation myocardial infarction (STEMI). This newly proposed equation is based on the three main independent predictors of 30-day survival: (i) baseline mortality risk; (ii) presentation delay risk; and (iii) p-PCI (vs. TL) delay.Tarantini's calculations showed that when the baseline mortality risk is 4%, the acceptable p-PCI (vs. TL) delay is only 35 min. Patients with higher baseline risk do benefit from a p-PCI strategy even when the transport times are extremely long: with 10% baseline risk the acceptable p-PCI delay is 153 min; with a baseline risk of 18% the acceptable p-PCI delay is (theoretically calculated) even >5 h (!).This result supports the widespread use of p-PCI and almost total abandonment of TL. For >80% of the European population, a cath-lab with a PCI programme is available within 30 min transport distance. It is ‘just’ a matter of appropriate organization of the regional networks: >80% of STEMI patients can be treated by p-PCI—as has been clearly demonstrated in several European countries.2 This study showed that over half … *Corresponding author. Tel: +420 267163159, Fax: +420 267162621, Email: widim{at}fnkv.cz

Primary angioplasty vs. thrombolysis: the end of the controversy?