Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, whose FMC-to-device time during primary PCI is 90 min *Patients with STEMI equivalent on ECG may have: hyperacute T-wave changes, true posterior MI, multilead ST depression with coexistent ST elevation in lead aVR, characteristic diagnostic criteria in the setting of LBBB. Denominator All patients with acute STEMI or its equivalent who receive primary PCI Denominator Exclusions Patients age <18 y Patients received in transfer from the inpatient, outpatient, or ED of another facility Denominator Exceptions Documentation of a medical reason for delayed primary PCI (eg, cardiopulmonary arrest, cardiogenic shock, vascular access or lesion-crossing issues, percutaneous circulatory assist device insertion, respiratory failure requiring intubation, and late presentation >12 h after symptom onset) Patients have received fibrinolytic therapy as the initial reperfusion therapy (eg, nonprimary PCI, rescue PCI) Patient currently enrolled in a clinical trial related to reperfusion therapy Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale Primary PCI has been shown to be superior to fibrinolytic therapy in recanalizing the infarct-related artery and imparts better clinical outcomes.90,91 In a meta- analysis of 23 trials randomizing a total of 7739 patients with acute STEMI to primary angioplasty or fibrinolytic therapy, primary angioplasty was superior in reducing short-term mortality, nonfatal reinfarction, stroke, and the combined cardiovascular endpoint.92 Primary angioplasty also resulted in higher rates of infarct artery patency, TIMI flow, lower rates of recurrent ischemia, emergency repeat revascularization procedures, and intracranial hemorrhage.92 The benefits of primary angioplasty persisted during long-term follow-up and were independent of the type of fibrinolytic therapy used.92 Clinical Recommendation(s) 2013 ACCF/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction12 1. 