Background: Timely performance of primary percutaneous coronary intervention (PCI) is the optimal reperfusion strategy for ST-elevation myocardial infarction (STEMI). Primary PCI is recommended even if patient is to be transported from non-primary PCI-capable hospital to primary PCI-capable hospital. This transport strategy is associated with an increased treatment delay. We implemented pre-hospital direct notification to cardiologist from the Emergency Medical Information Center in our city to reduce inter-hospital delay and to activate catheterization laboratory (Cath Lab) at the STEMI receiving center (SRC) simultaneously. The aim of this study was to evaluate the impact of pre-hospital direct notification to cardiologist and pre-hospital activation of Cath Lab on the rate of timely reperfusion for STEMI with primary PCI. Methods: Since January 2009, we implemented 24-hr hotline system between cardiologists at our institution and the Emergency Information paramedic system in our city. A total of 178 consecutive STEMI patients who underwent primary PCI from January 2009 through June 2010 were included for this study. Baseline clinical characteristics, time interval parameters, and angiographic and procedural characteristics were compared between patients with or without pre-hospital notification and activation of Cath Lab. Results: Pre-hospital notification to cardiologist and activation of Cath Lab was performed in 74 (42%) patients (72% male, age 63 짹 11 years) of the primary PCI cohort. There were no differences in baseline clinical and angiographic characteristics between patients with or without pre-hospital notification. Pre-hospital notification and activation of Cath Lab was associated with a significantly shorter median door-to-balloon time (DTB) (53.5 vs. 69.5 min, p = 0.007), a difference that was particularly pronounced during ���off-duty��� hours or holidays (54 vs. 82 min, p <0.001). Patients with pre-hospital notification and activation of Cath Lab achieved an 87.8% rate of DTB ���90 min (vs. 73.1% in patients without pre-hospital notification, p = 0.024). There were no significant differences in infarct size determined by peak troponin levels. In-hospital mortality was not different (4.1% vs. 5.8%, p = 0.738). Conclusions: Pre-hospital direct notification to cardiologist and activation of Cath Lab at the SRC significantly reduced DTB and significantly increased the rate of DTB ���90 min in patients with STEMI when patients were transported from non-primary PCI-capable hospitals to SRC. These findings suggest that regional organization of SRC networks is needed to ensure quality STEMI care and to delineate the ideal reperfusion strategy for a given community.