Net benefit effect demonstrated in randomized clinical trials (RCT) might not be the same as that observed in different clinical settings. Large observational registries are needed in order to assessing treatment effectiveness in patients encountered in day-to-day clinical practice, undergoing everyday therapy.

After the publication of pivotal randomized trial and large registries, there were significant changes in the current practice of primary PCI in a high primary PCI-volume catheterization laboratory.

We reported an increase of the trans-radial approach, of the use of either bivalirudin or new antiplatelet drugs or DES and a significant decrease of the use of either GP IIb–IIIa inhibitors or IABP. Conversely the rates of manual thrombus aspiration and multivessel PCI remained almost unchanged.

These changes could have had an impact on procedural efficacy.