Early abciximab administration before primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) is believed to improve outcome. However, the evidence supporting abciximab use before and during transfer for PPCI is limited. Aim: To assess safety and the effect of early abciximab administration in patients (pts) with first anterior wall STEMI. Methods: A total of 59 non-shock pts with STEMI <12h admitted to remote hospitals with anticipated delay to PPCI < 90 min were randomly assigned to two study groups – 27 pts received abciximab before transfer to cath lab (early=group EA) and 32 pts in cath lab immediately before PPCI (late=group LA). Results: Better infarct-related artery patency before PPCI and better ST-segment resolution 60 min after PPCI was found in EA group. There was a significant difference in 30-day left ventricular end-systolic volume index-ESVI and end-diastolic volume index-EDVI and a trend in ejection fraction-EF in echocardiography favoring EA group. In cardiac magnetic resonance sub-study lower ESVI, EDVI and higher EF was found in EA group after 1 year. A trend towards lower delayed enhancement infarct size was also observed in EA group. Similar rate of bleeding complications and major adverse events was found in both groups. Conclusions: Early abciximab administration before transfer for PPCI in patients with first anterior wall STEMI is feasible and results in more frequent infarct-related artery patency before PPCI, better myocardial tissue perfusion after PPCI and improved left ventricular function during 30-day and 1-year follow up.