One way to see the chorus of emergency angioplasty treatment of acute heart attack is with awe. Another is with utter frustrationโbecause in most cases it is unnecessary- John Mandrola recently summed up beautifully. A 2014 population based study from Sweden (J Am Coll Cardiol 2014; 64:1299-1306) shows that if people eat less, walk more, do not smoke, drink alcohol in moderation and reduce their belt size, four of five MIs- yes four of five heart attacks- in men could be preventable. The high- cost, technology -driven cardiac care continues to dominate over low-cost, high- value primary prevention, worldwide. Why, would Mandeep R. Mehra please tell us?