***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    Input: Background — Traditional reperfusion options for patients with acute ST-segment elevation myocardial infa rct ion ( STEMI ) presenting to non- primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI . A third option , involving interventionalist transfer , was examined in the REVERSE-STEMI study . Methods and Results — A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were r and omized to receive PPCI  with either an interventionalist- ( n=165 ) or a patient-transfer ( n=169 ) strategy . The primary end point of door-to-balloon ( D2B ) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events ( MACE ) at 1-year clinical follow-up were compared between the 2 groups . Compared with the patient-transfer strategy , the interventionalist-transfer strategy result ed in a significantly shortened D2B time ( median , 92 minutes versus 141 minutes ; P<0.0001 ) , with more patients having first balloon angioplasty within 90 minutes ( 21.2 % versus 7.7 % , P<0.001 ) . This treatment strategy also was associated with higher left ventricular ejection fraction ( 0.60±0.07 versus 0.57±0.09 , P<0.001 ) and improved 1-year MACE-free survival ( 84.8 % versus 74.6 % , P=0.019 ) . Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE ( hazard ratio , 0.63 ; 95 % CI , 0.45 to 0.88 ; P=0.003 ) . Conclusions — The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital , particularly in a congested cosmopolitan region where patient transfers could be prolonged . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT00713557 AIMS We investigated the net benefit in the outcome of reducing treatment delay through field triage and emergency department ( ED ) bypass in patients with ST-elevation myocardial infa rct ion ( STEMI ) treated with primary angioplasty .  METHODS AND RESULTS In a prospect i ve registry study , consecutive patients with suspected STEMI were assigned to : ( i ) pre-hospital ECG and triage or ( ii ) ECG and triage at the closest ED , solely based on ambulance availability . Four district hospitals and one regional heart centre serviced the 890,000 population metropolitan area and primary angioplasty was the only reperfusion strategy employed . Baseline characteristics were similar in STEMI patients triaged in the field ( 108 ) and the EDs ( 193 ) . Symptom onset to balloon times : 154 [ inter-quartile range ( IQR ) 120 - 233 ) vs. 249 ( IQR 184 - 405 ) min ( P<0.001 ) and peak creatine kinase in early presenters ( < 2 h ) : 1435 ( 95 % CI : 904 - 1966 ) U/L vs. 2320 ( 95 % CI : 1881 - 2762 ) U/L ( P=0.009 ) were lower in field- than in ED-triaged patients . Mortality in the PCI treated were 1.1 and 8.2 % [ P=0.025 , RR 0.14 ( 95 % CI : 0.01 - 1.08 ) ] and overall mortality were 1.9 and 7.3 % [ P=0.046 , RR 0.26 ( 95 % CI : 0.05 - 1.11 ) ] . CONCLUSION Field-triage and ED bypass were feasible means of reducing treatment delay in patients with suspected STEMI and result ed in smaller infa rct size in early presenters and a trend towards a reduction in mortality Objective To investigate the potential benefit of an earliest possible out-of-hospital start of abciximab ( ReoPro ) therapy in ST-elevation myocardial infa rct ion ( STEMI ; Lilly , Bad Homburg , Germany ) and planned primary percutaneous intervention compared with periprocedural abciximab treatment on reperfusion and clinical outcome . Methods R and omization of one hundred and one patients with STEMI to prehospital or periprocedural abciximab treatment . Evaluation of thrombolysis in myocardial infa rct ion ( TIMI ) flow , ST-segment resolution , myocardial blush grade , and maximal creatine kinase release before and after as well as clinical follow-up until 6 months after the index event . Results Prehospital abciximab ( group 1 ) was initiated a median of 101 min ( 37–165 min ) earlier compared with periprocedural treatment ( group 2 ) . Initial TIMI 3 flow ( 24 vs. 15 % , P = NS ) , ST-segment resolution before percutaneous coronary intervention ( PCI ) ( < 30 % : 33 vs. 46 % , P = NS ; > 70 % : 38 vs. 33 % , P = NS ) , post-PCI myocardial blush grade 2 and 3 ( 72 vs. 75 % , P = NS ) , maximal cardiac enzyme release ( creatinine kinase MB median 77 U/l ; range 33–137 vs. 74 U/l ; range 39–143 U/l , P = NS ) , and 6 months follow-up ( recurrent myocardial infa rct ion or repeat coronary intervention , and PCI , need for coronary bypass surgery ) did not differ significantly between both treatment groups . Conclusion Prehospital intravenous administration of abciximab , although safe and feasible in a trained surrounding , does not add angiographic or clinical benefit to patients with STEMI BACKGROUND Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infa rct ion , they have not been directly compared . Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis . METHODS We did a r and omised multicentre trial of 840 patients ( of 1200 planned ) who presented within 6 h of acute myocardial infa rct ion with ST-segment elevation , initially managed by mobile emergency-care units . We assigned patients to  prehospital fibrinolysis ( n=419 ) with accelerated alteplase or primary angioplasty ( n=421 ) , and transferred all to a centre with access to emergency angioplasty . Our primary endpoint was a composite of death , non-fatal reinfa rct ion , and non-fatal disabling stroke at 30 days . Analyses were by intention to treat . FINDINGS The median delay between onset of symptoms and treatment was 130 min in the prehospital-fibrinolysis group and 190 min ( time to first balloon inflation ) in the primary -angioplasty group . Rescue angioplasty  was done in 26 % of the patients in the fibrinolysis group . The rate of the primary endpoint was 8.2 % ( 34 patients ) in the prehospital-fibrinolysis group and 6.2 % ( 26 patients ) in the primary -angioplasty group ( risk difference 1.96 , 95 % CI -1.53 to 5.46 ) . 16 ( 3.8 % ) patients assigned prehospital fibrinolysis and 20 ( 4.8 % ) assigned primary angioplasty  died ( p=0.61 ) . INTERPRETATION A strategy of primary angioplasty was not better than a strategy of prehospital fibrinolysis ( with transfer to an interventional facility for possible rescue angioplasty ) in patients presenting with early myocardial infa rct ion OBJECTIVE To assess the safety and feasibility of acute transport followed by rescue percutaneous transluminal coronary angioplasty ( PTCA ) or primary PTCA in patients with acute myocardial infa rct ion initially admitted to a hospital without PTCA facilities . DESIGN In a multicentre r and omised open trial , three regimens of treatment of acute large myocardial infa rct ion were compared for patients admitted to hospitals without angioplasty facilities : thrombolytic treatment with alteplase ( 75 patients ) , alteplase followed by transfer to the PTCA centre and ( if indicated ) rescue PTCA ( 74 patients ) , or transfer for primary PTCA  ( 75 patients ) . RESULTS Between 1995 and 1997 224 patients were included . Baseline characteristics were distributed evenly . Transport to the PTCA centre was without severe complications in all patients . Mean ( SD ) delay from onset of symptoms to r and omisation was 130 ( 75 ) minutes and from r and omisation to angiography 90 ( 25 ) minutes . Death or recurrent infa rct ion within 42 days occurred in 12 patients in the thrombolysis group , in 10 patients in the rescue PTCA group , and in six patients in the primary PTCA group . These differences were not significant . CONCLUSIONS Acute transfer for rescue PTCA or primary PTCA in patients with extensive myocardial infa rct ion is feasible and safe . Efficacy of rescue PTCA or primary PTCA in this setting will have to be tested in larger series before this approach can be implemented as “ routine treatment ” for patients with extensive myocardial infa rct ion BACKGROUND For the treatment of myocardial infa rct ion with ST-segment elevation , primary angioplasty is considered superior to fibrinolysis for patients who are admitted to hospitals with angioplasty facilities . Whether this benefit is maintained for patients who require transportation from a community hospital to a center where invasive treatment is available is uncertain . METHODS We r and omly assigned 1572 patients with acute myocardial infa rct ion to treatment with angioplasty or accelerated treatment with intravenous alteplase ; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centers . The primary study end point was a composite of death , clinical evidence of reinfa rct ion , or disabling stroke at 30 days . RESULTS Among patients who underwent r and omization at referral hospitals , the primary end point was reached in 8.5 percent of the patients in the angioplasty group , as compared with 14.2 percent of those in the fibrinolysis group ( P=0.002 ) . The results were similar among patients who were enrolled at invasive-treatment centers : 6.7 percent of the patients in the angioplasty group reached the primary end point , as compared with 12.3 percent in the fibrinolysis group ( P=0.05 ) . Among all patients , the better outcome after angioplasty was driven primarily by a reduction in the rate of reinfa rct ion ( 1.6 percent in the angioplasty group vs. 6.3 percent in the fibrinolysis group , P<0.001 ) ; no significant differences were observed in the rate of death ( 6.6 percent vs. 7.8 percent , P=0.35 ) or the rate of stroke ( 1.1 percent vs. 2.0 percent , P=0.15 ) . Ninety-six percent of patients were transferred from referral hospitals to an invasive-treatment center within two hours . CONCLUSIONS A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis , provided that the transfer takes two hours or less Background — The value of prehospital initiation of glycoprotein IIb/IIIa inhibitors remains a controversial issue . We sought to investigate whether in-ambulance initiation of abciximab in patients with ST-segment elevation myocardial infa rct ion ( STEMI ) improves ST-segment elevation resolution ( STR ) after primary percutaneous coronary intervention ( PCI ) . Methods and Results — MISTRAL ( Myocardial Infa rct ion with ST-elevation Treated by Primary Percutaneous Intervention Facilitated by Early Reopro Administration in Alsace ) is a prospect i ve , r and omized , double-blind study . Two hundred and fifty-six patients with acute STEMI were allocated to receive abciximab either in the ambulance ( ambulance group , n=127 ) or in the catheterization laboratory ( hospital group , n=129 ) . The primary end point was complete ( > 70 % ) STR after PCI . Complete STR was not significantly different between the 2 groups ( before PCI , 21.6 % versus 15.5 % , P=0.28 ; after PCI , 70.3 % versus 65.8 % , P=0.49 ) . Thrombolysis In Myocardial Infa rct ion ( TIMI ) 2 to 3 flow rates before PCI tended to be higher in the ambulance group ( 46.8 % versus 35 % , P=0.08 ) but not after PCI ( 70.3 % versus 65.8 % , P=0.49 ) . Slow flow tended to be lower ( 5.6 % versus 13.4 % , P=0.07 ) , and distal embolization occurred significantly less often in the ambulance group 
    Output:
    
Conclusion : Field triage compared to referral via a spoke centre leads to a lower 30-day mortality in STEMI patients .