In the treatment of acute myocardial infarction (AMI), the length of time from symptom onset to revascularization is a crucial determinant of clinical outcomes such as mortality and reinfarction. Direct, or primary, percutaneous transluminal coronary angioplasty (PTCA) produces higher rates of infarct-related artery patency and improved clinical outcomes compared to thrombolytic therapy. However, primary PTCA is associated with an increased time interval from hospital arrival to revascularization, the so-called door-to-balloon time. Numerous data support the theory that increased door-to-balloon time reduces the benefits of primary PTCA in the treatment of AMI. Therefore, institutions that offer PTCA must strive to decrease door-to-balloon delays through the use of established treatment protocols and frequent assessment of performance.