Although primary angioplasty (PTCA) achieves reperfusion in acute myocardial infarction (AMI) more readily than thrombolysis without the risk of intracranial haemorrhage, economic and logistic issues limit its applicability.1 Most patients with AMI present to hospitals without cardiac catheterisation facilities, let alone PTCA expertise. The safety and feasibility of the emergency transfer of such patients for primary PTCA have been reported by Zijlstra et al in Zwolle, a high volume centre in the Netherlands performing 1600 angioplasties annually.2During five years there were 520 cases of primary PTCA, 104 of which were transferred from other hospitals, 91% from within a 50 km radius. One patient was ventilated before transfer. During transfer, another was intubated, three patients had ventricular fibrillation or tachycardia, and one of 10 patients in cardiogenic shock on inotropic support died. Although the time lost between admission to the local hospital and arrival at the PTCA laboratory averaged 70 minutes, the first balloon inflation was performed within six hours of symptom onset in 78% of cases. In this well established programme, there was no difference in mean time from symptom onset to first inflation between transferred (200 minutes) and directly admitted (196 minutes) patients.