Over the recent years it has been clearly demonstrated that reperfusion by primary angioplasty in patients with ST-elevation myocardial infarction (STEMI) is the treatment of choice. For hospitals without the capacity of performing primary angioplasty, reperfusion with on-site thrombolysis or transportation of the patient to another institution for primary percutaneous coronary intervention (PCI) within a tight frame rate are the alternative options. For the latter strategy, an organized network of centers is needed to rapidly transfer STEMI patients for primary PCI. Although transferring STEMI patients for primary PCI is superior reperfusion therapy in comparison to on-site thrombolysis, there are concerns, regarding time delays of transfer in daily practice, which is a major drawback of this therapeutic strategy as delays of >120min from first medical contact to primary PCI negate the advantage of primary PCI over thrombolysis. The narrow time interval (<90-120min) that is mandatory for the superiority of primary PCI, could be extended if a pharmacoinvasive strategy (fibrinolysis followed by routine “early” angioplasty of the culprit artery) was chosen. Convincing results from trials such as TRANSFER-AMI, FAST-MI, GRACIA-2, WEST-MI, CARESS-AMI, NORDISTEMI and STREAM indicated that combined use of thrombolysis and PCI in a sufficient time course (>3hours to 6-12hours), in order to neutralize the pre-hemorrhagic effects of thrombolysis and allow full action of antiplatelet and antithrombotic agents, had comparable efficacy in comparison to primary PCI regarding early and 1 year survival. This appears to be an effective alternative option for the treatment of STEMI patients, at least for those hospitals whereby immediate PCI is unavailable
