The findings from this and other studies indicate that high- risk patients with STEMI appear to benefit from immediate transfer for early catheterization, compared with either an ischemia-guided approach or delayed routine catheterization The reported benefits relate to a reduction in the incidence of recurrent infarction or isch- emia, thus favoring earlier transfer and revascularization when possible. The NORDISTEMI (Norwegian Study on District Treatment of ST-Elevation Myocardial Infarction) investi- examined the effect of immediate routine trans- fer for catheterization versus a conservative strategy with either ischemia-guided treatment in the non PCI-capable hospital or transfer for rescue PCI. Although this study failed to demonstrate a significant difference between the 2 treatment groups in the incidence of the primary com- posite endpoint of death, recurrent MI, stroke, or new or recurrent ischemia at 1 year, the incidence of death, recur- rent MI, or stroke was significantly lower in the immediate- transfer group. Furthermore, the magnitude of reduction in risk was similar to that reported for high-risk patients in the In a meta-analysis359 that included 7 RCTs of early transfer for catheterization, a strategy of routine early catheterization after fibrinolysis was associated with a statistically significant reduction in the incidence of death or MI at 30 days and at 1 year, without an increase in the risk of major bleeding. This meta-analysis was based on a mixture of trials that random- ized high-risk patients360,361,369 and trials that did not mandate the inclusion of high-risk subjects. 