International Circulation: You mentioned that you are in the Netherlands. We know that shortening door-to-balloon time to as short as possible is critical to restore perfusion of STEMI patients. In China， which is a very large country with an extensive portion of the population living in rural areas or remote， it can be difficult to get these patients to receive reperfusion therapy in time. Is there any advice that you could give to your Chinese colleagues of how they could try to solve this problem?
Harry Suryapranata: Again I would like to stress organization. It is just necessary to have a good organization. If you learn from countries in Scandanavia， which has very large， vast countries， and less people. Australia and Eastern Europe are also examples of places who have been able to organize the management of these treatments well. To have certain key PCI centers in certain areas， as well as organize the ambulance services to bring those patients to those PCI centers. Of course， this is the ideal. If you look at Europe who overall have good organization， there still remain rather significant differences between countries. It is sad to see that in some countries too many patients don’t have a form of accessible reperfusion therapy still today. The consciousness to have this organization in mind helps a lot because the implementation of the guidelines of primary PCI has resulted in an enormous increase in the use of reperfusion therapy. Thrombolytic drugs are not a bad idea to have available for those very remote places. A key issue is that it must be distinguished between high-risk infarctions and small-risk infarctions. In high-risk patients with acute MI there are fewer if any concessions， they must be sent to have primary PCI. For all other lower risk patients it is acceptable to think of other modalities. My advice would be to concentrate on those high-risk patients.
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