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M any clinical trials have shown that primary percutaneous coronary intervention (PPCI) is more effective than thrombolysis for the treatment of ST-segment elevation myocardial infarction (STEMI).1 According to current guide-lines, PPCI is the preferred form of reperfusion treatment for patients with STEMI. However, advantages of an invasive approach over fibrino-lytic treatment may be blunted by several factors. Most important include low availability of experi-enced institutions offering 24 hour/7 day PPCI service and delay to invasive treatment due to prolonged transport. The delayed initiation of reperfusion treatment and its effect on clinica