Reconsidering Transfer for Percutaneous Coronary Intervention Strategy: Time Is of the Essence

For patients presenting with acute ST-segment elevation myocardial infarction (STEMI), timely reperfusion is a life-saving treatment. The benefit is closely related to rapidity of reperfusion, as “time is muscle.” Studies showing that primary percutaneous coronary intervention (pPCI) has a mortality advantage over thrombolytics¹ have led to its dominance as the preferred revascularization strategy in the United States. Furthermore, older data² showing improvement in outcomes for patients with STEMI receiving pPCI even when this requires transfer to another facility, instead of thrombolysis, have led to the adoption of the “transfer for PCI” strategy, if transfer can be accomplished in a timely fashion. However, this remains a big “if.”