Principal Findings:

Due to poor recruitment, the study was terminated after enrollment of 138 patients (32% of the projected sample size). Of these, 67 patients were randomized to thrombolytic therapy, and 71 patients were randomized to emergency transfer and primary PTCA. The median door to therapy time were 51 minutes in the thrombolytic therapy group and 155 minutes in the transfer group. Most of the delay in treatment in the transfer group was due to initiation of transfer (43 minutes) and transport time (26 minutes), while time from arrival to hospital to catheterization laboratory (11 minutes) and time from catheterization laboratory arrival to treatment (14 minutes) were short. No deaths occurred during transfer. In the transfer group, 100% of patients underwent cardiac catheterization, 89% had primary PTCA, 2 patients were treated medically and 6 patients were referred for coronary artery bypass surgery. Coronary stents were used in 34% of patients. At 30-days follow-up, there was a non-significant trend toward a lower incidence of the combined endpoint in the transfer group when compared with the thrombolytic therapy group (8.4% versus 13.6% P = 0.331). Multivariate logistic regression analysis identified randomization to transfer as independent predictor of a reduction in the primary end-point (OR 0.159, 95% CI 0.031-0.820, p=0.028).