<International Circulation>: When STEMI patients are presented to non-percutaneous coronary intervention facilities， the management of these patients revolves around drug strategies. What is your approach for these cases?

    Dr Hochman:Opening the infarct-related artery is the primary goal of therapy in general STEMI patients. If you can do primary angioplasty within 90 minutes of first medical presentation， then go ahead and do angioplasty. If you cannot， then fibrinolytic therapy is indicated. For high risk patients， after fibrinolytic therapy， in general we think it is reasonable to transport them to a centre that can perform angioplasty and define the coronary anatomy. For low risk patients， it is not necessary to transport them. These patients get their fibrinolytic therapy， are stable， are low risk and can stay in the admitting hospital. For cardiogenic shock patients， there is a more compelling need  to transfer them. But if there is going to be a delay in opening that artery by angioplasty for patients within the first few hours of MI onset，  the same would apply- you would give fibrinolytic therapy first then transfer them.