Siddiqi TJ, et al. - Researchers compared pharmacoinvasive therapy (PIT) to primary percutaneous coronary intervention (PPCI) in terms of safety and efficacy in transfer ST-elevation myocardial infarction patients presenting to non-PCI capable hospitals. They analyzed data from relevant randomized controlled trials (RCTs) and observational studies searched from electronic databases. PIT was defined as administration of thrombolytic drugs followed by immediate PCI only in case of failed thrombolysis. Using a random-effects model, results were pooled from 17 relevant studies (6 RCT's, 11 observational studies) including 13,037 patients. Short-term mortality did not differ significantly; however, studies with a symptom-onset-to-device time ≥200 minutes showed significant decrease in short-term mortality with PIT. There was a significantly lower risk re-infarction in the PPCI group, while the risk of cardiogenic shock was significantly higher. Overall, in these patients, customization was recommended for PIT vs PPCI decisions, preferably, taking into account symptom-onset to first medical contact time, expected time of transfer to a PCI-capable hospital, and individual risk factors.