Since the introduction of coronary artery bypass graft surgery (CABG) in 1968 and percutaneous coronary angioplasty (PTCA) in 1977 with subsequent stenting (bare-metal in 1987 and drug-eluting in 1991) both CABG and percutaneous coronary intervention (PCI) remain a therapeutic option for many patients with coronary artery disease (CAD) today [ ]. The treatment of acute myocardial infarction (AMI) has also evolved tremendously over the past several years. All methods of therapy used during this time were and are designed to limit infarct size. These therapies can be most successful when they are applied within the first 4 to 6 h (preferably the first 2 h) of the onset of the acute event. In the common presentation of AMI (ST Elevation Myocardial Infarction; STEMI) outside the hospital, it is logistically challenging to bring the patient to the hospital, carry out a clinical evaluation, assess the coronary anatomy by angiography, assemble a surgical team, commence surgery and place the patient on cardiopulmonary bypass in less than 4 h after the onset of symptoms. Systems of care for STEMI have been created to provide rapid access to the catheterization laboratory and guidelines recommend appropriate revascularization in a timely manner with PCI as a first-line treatment when feasible [ ].