In many communities, a significant percentage of patients with STEMI who present initially to a non PCI-capable hos- pital cannot physically be transferred to a PCI-capable hos- pital and achieve an FMC-to-device time treatment goal of 90 minutes. DANAMI-2 (Danish Multicenter Randomized Study on Thrombolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction) showed that a reperfusion strategy involving the transfer of patients with STEMI from a non PCI-capable hospital to a PCI-capable hospital for primary PCI was superior to the use of fibrino- lysis at the referring hospital, driven primarily by a reduc- tion in the rate of reinfarction in the primary PCI treated In this study, the average first door-to-device time delay was approximately 110 minutes.85 Shorter system delays were associated with a reduced mortality rate for both fibrinolysis- and primary PCI treated patients. In an analysis of approximately 19000 propensity score matched patients with STEMI from NRMI-2, -3, -4, and -5, when delays related to transfer for primary PCI exceeded 120 minutes from FMC, the survival advantage of primary PCI over fibrinolysis was negated. Delays beyond 120 minutes occurred in nearly half the patients in the analysis.100 Thus, interhospital transfer to a PCI-capable hospital is the recommended triage strategy if primary PCI consistently can be performed within 120 min- utes of FMC. Fibrinolytic therapy, in the absence of contrain- dications to its use, should be administered within 30 minutes of first door arrival when this 120-minute time goal cannot be met. Transfer delays can occur at multiple levels and for Efforts are needed to reduce the time delay between arrival to and transfer from a non PCI-capable hos- pital (ie, door-in door-out). 