Background An increasing number of patients have an acute coronary syndrome while abroad. Such an event may entail significant emotional and financial stress, and patients are usually anxious to return home as soon as possible. The safety of long-distance air travel soon after an acute coronary syndrome is, however, uncertain, and few data exist regarding the evaluation of such patients, the proper timing and conditions of the flight, and short-term complications. Methods and Results We prospectively evaluated 21 tourists who had an acute coronary syndrome in Jerusalem. Patients at high risk were offered angiography; others underwent stress testing. Telephone interviews were conducted a few weeks after the patients returned home, and follow-up information was obtained. Patients flew home 18.2 ± 11 days (mean ± SD) after the acute event. Flight duration was substantial (12.5 ± 3 hours). No patient had cardiac symptoms en route. At follow-up (21.3 ± 13 days), all but 2 patients were alive and free of cardiac symptoms. Conclusions A long-distance flight within 2 to 3 weeks after an acute coronary syndrome is reasonably safe, provided significant ischemia is excluded or treated. (Am Heart J 2000;140:241-2.)