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The use of primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy in ST-elevation myocardial infarction (STEMI) requires optimal systems-of-care and logistics in order to enable rapid treatment of all patients. In Denmark, this has been achieved through prehospital electrocardiogram diagnosis, field triage and dedicated PCI centres 24/7. Today, primary PCI is an option for all Danish patients with STEMI, regardless of the distance to a PCI centre. This has led to a decline in both mortality and morbidity.

Today there is solid evidence that high-risk patients with acute myocardial infarction without ST-elevation should undergo routine invasive treatment, preferably with a very short delay. Evidence suggests that acute coronary occlusions are present in many of these patients. Nevertheless, so far no studies have been powered to evaluate the impact of primary percutaneous coronary intervention on outcome in this patient population. With the advanced, prehospital, diagnostic possibilities available today it would be possible to investigate this issue further.

Overall, the future emergency departments in Denmark serve as a single portal of entry for all acute patients. At the same time an expansion of prehospital diagnosing and triage will take place. In patients suspected of life-threatening cardiac conditions with specialized treatment requirements where the time factor is important, the prehospital triage will be important to identify patients who should be transferred directly to a cardiac care unit to reduce prehospital and in-hospital delays of treatment.