In the largest experience of transfer for primary PCI, the Danish Multicenter Randomized Trial on Thrombolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI-2), 1,572 patients with STEMI were randomly assigned to on-site accelerated tissue plasminogen activator or primary PCI at 24 hospitals in Denmark (9). Patients who were randomized to primary PCI at referral centers were transferred to one of five invasive centers, provided that transfer would likely take <3 h. Transfer for primary PCI was well tolerated, with no deaths or serious adverse events. The median transfer distance was 50 km (range, 3 to 150 km), and the median transfer time was 67 min (interquartile range, 50 to 85 min). The DANAMI-2 trial was stopped early because of an approximately 40% lower incidence of the primary end point of recurrent MI, disabling stroke, or death at 30 days with primary PCI compared with fibrinolysis (8.5% vs. 14.2%; p = 0.002). However, the significance of these findings has been questioned because: 1) recurrent MI was the only end point that was significantly reduced with primary PCI; 2) different definitions of MI were used in the two treatment groups; and 3) early-rescue PCI was prohibited for reperfusion failures in the fibrinolytic group. Nonetheless, the Danish experience reveals that a cohesive network of centers could rapidly and safely transfer STEMI patients for primary PCI.