Possible risks to patients receiving statins combined with other medications.

infarction (AMI) patients eligible for enrollment in the study. Dr. Silverman questioned the safety of transfer of the AMI patient. Although his concerns are valid, all emergency medical systems that would be transferring AMI patients are trained in advanced cardiac life support. These systems should be able to resuscitate AMI patients, as well as the staff in the emergency department or intensive care units of small hospitals. In fact, five randomized trials of transfer for primary angioplasty have shown that transfer is safe and is associated with better outcomes compared to on site thrombolytics (1–5) (Table 1). Experienced angioplasty operators may safely perform primary angioplasty in diagnostic catheterization laboratories. However, the expense of training staff, both in the laboratory and in recovery units, in addition to stocking expensive angioplasty equipment, may not be feasible in small hospitals. Finally, it would be far easier to instruct emergency medical staff drivers to head in the correct direction—toward a primary angioplasty facility.