Experiences with primary angioplasty without on site-cardiac surgery.

Growing evidence suggests that primary angioplasty is superior to thrombolysis for the treatment of acute myocardial infarction, in particular in some high-risk subsets. The performance of primary angioplasty in centres without on-site cardiac surgery may extend the availability of this effective reperfusion therapy. This will benefit in particular those patients who would not be treated otherwise. Optimal primary angioplasty requires a high level of logistic organization, operator expertise, and commitment of the whole team. The outcome does not depend on the presence or absence of surgeons on site. In fact, feasibility, safety and efficacy of primary angioplasty are similar in both types of centres when high standards of care are guaranteed.