Quickly re-establishing coronary blood flow is vital in patients with ST elevation myocardial infarction. Two recently published systematic reviews summarise the evidence on this form of treatment.1 2 The first review concluded that primary percutaneous coronary intervention (PCI) is the best reperfusion strategy if performed quickly, and it identified “door to balloon time” (the time from arrival at hospital to balloon inflation) as a key predictor of outcome in people given this treatment.1 The second review stated that “inevitable transport delays commonly limit the benefit of PCI.”2 The reviews reflect an ongoing controversy in cardiology—when is PCI the best reperfusion strategy, and when should fibrinolysis be considered as an alternative?

What is an acceptable time window in which to deliver PCI? The review by Boden and colleagues and current guidelines recommend using fibrinolysis if the extra time needed to perform percutaneous coronary intervention (the PCI related delay) is more than 60 minutes, or if …