The aim of this contribution is to draw considerations on the first year of activity of a cath lab on call 24/24 h for primary coronary angioplasty (PTCA) (April 2007-April 2008) of a small hospital without surgical backup. We performed 152 primary PTCA in 156 patients presenting to the emergency room with ST-elevation myocardial infarction. The mean time from arrival to the emergency room to the insertion of the arterial introducer was 48 min. Patient management included a 12-lead ECG and family history, the telephone call to the hospital cardiologist and then to the cath lab operator and nurse. Procedural success was obtained in 97% of cases. Mortality was 6%. Other complications occurred in 4% of patients. The no-reflow phenomenon occurred in 4% of patients. We used 1.9 stents/patient. Direct stenting was performed in 43% of cases. In 14% of lesions, the procedure was concluded with only balloon angioplasty. The radial access was used in 15% of patients, whereas the femoral access was used in the remainder. Drug-eluting stents were implanted in 1% only of patients with acute myocardial infarction. Glycoprotein IIb/IIIa inhibitors and clopidogrel were extensively used prior to the procedure. Our data, although obtained in a smaller population sample and referring to a relatively short period of time, are similar to those of the American registry on PTCA. In conclusion, the results obtained in our center with the invasive management of acute myocardial infarction appear consistent with those of other centers and encourage us to continue along our chosen path.