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ContextRapid time to treatment with thrombolytic therapy is associated with lower mortality in patients with acute myocardial infarction (MI). However, data on time to primary angioplasty and its relationship to mortality are inconclusive.ObjectiveTo test the hypothesis that more rapid time to reperfusion results in lower mortality in the strategy of primary angioplasty.DesignProspective observational study of data collected from the Second National Registry of Myocardial Infarction between June 1994 and March 1998.SettingA total of 661 community and tertiary care hospitals in the United States.SubjectsA cohort of 27,080 consecutive patients with acute MI associated with ST-segment elevation or left bundle-branch block who were treated with primary angioplasty.Main Outcome MeasureIn-hospital mortality, compared by time from acute MI symptom onset to first balloon inflation and by time from hospital arrival to first …