Our data do not allow us to reach a firm conclusion about the role of primary angioplasty in the care of these patients. The decline in mortality might have been greater had primary angioplasty been more readily available in Quebec.

William Panton suggests the use of magnesium therapy for patients admitted to hospitals that are not fully equipped to carry out invasive cardiac procedures. Thrombolytic therapy certainly can be used in peripheral hospitals and it is more effective than use of magnesium sulfate. Magnesium sulfate has been extensively studied; its effectiveness remains controversial in view of the contradictory conclusions of a meta-analysis and a large clinical trial. Before we push the use of controversial treatments, we should maximize the use of treatments that are known to be effective.