Correspondence: Dr. Giuseppe De Luca. Cardiologia Intervencionista. Division de Cardiologia. Hospital Maggiore della Carita. Universidad del piemonte Oriental. Corso Mazzini, 18. 28100 Novara. Italia. E-mail: giuspepe.deluca@maggioreosp.novara.it See article on pageS 15-22 A recent meta-analysis of 23 randomized trials has shown that primary angioplasty is associated with a significant reduction in mortality and reinfarction at 30 days.1 These benefits have been explained by a higher rate of TIMI 3 flow achieved by primary angioplasty as compared to thrombolysis. Several reports have shown the safety of transfer for primary angioplasty.2,3 The superiority of primary angioplasty as compared to on-site thrombolysis has been confirmed even when transfer is needed.4 Together, these data have encouraged clinicians to extend primary angioplasty to the vast majority of ST elevation myocardial infarction (STEMI) patients. An increasing number of primary percutaneous coronary intervention (PCI) procedures has been observed in last years across Europe, including Spain.5 However, a larger proportion of mechanical recanalization is not a guarantee of optimal reperfusion. In fact, primary angioplasty requires well-run regional networks, that actually limits a timely application of the procedure to a minority of patients.