Aims: This study aimed to compare air (AIR) and ground transport (GRD) of STEMI patients bound for primary percutaneous coronary intervention (pPCI). Methods and results: This was a prospective, controlled, observational study, including patients in whom STEMI was suspected outside a 30-minute driving distance from the PCI centre. AIR patients in a 12-month period (May 1, 2010, to April 30, 2011) were compared with GRD patients in a 16-month period (January 1, 2010, to April 30, 2011). The primary endpoint was time from ECG consistent with STEMI to arrival in the cardiac catheterisation laboratory. We included 450 patients, 114 AIR and 336 GRD patients. The median (5-95% range) transport distance was 97 (62-162) vs. 94 (64-172) kilometres, respectively (p=0.01). Time from ECG to cardiac catheterisation laboratory arrival was significantly lower in the AIR group (median 84 minutes (60-160) vs.104 minutes [63-225], p<0.01). Time from ECG to balloon was 114 (78-221) minutes vs.132 (84-262) (p<0.01), respectively. The 30-day mortality was 2.2% (2/91) for AIR and 6.9% (18/262) for GRD patients (p=0.10). One-year mortality was 6.7%, (6/90) vs. 9.9% (26/262) (p=0.35), respectively. Conclusions: Air transport seemed superior to ground transportation in reducing time from ECG diagnosis to arrival in the catheterisation laboratory for STEMI patients outside a 30-minute driving distance to the PCI centre.