Continued 22 Short Title: PM-7: Door-to-Needle Time PM-7: Acute STEMI: Time to Fibrinolytic Therapy Measure Description: Percentage of patients, age 18 y, with acute STEMI, or its equivalent, who receive fibrinolytic therapy (as the primary reperfusion modality) with a time from hospital arrival to fibrinolysis 30 min. Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, whose time from hospital arrival to fibrinolytic therapy (DTN time) is 30 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 and its equivalent 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 fibrinolytic therapy (eg, cardiopulmonary arrest, initial suspicion of bleeding/stroke or other contraindications to use fibrinolytic therapy, respiratory failure requiring intubation, intra-aortic balloon pump insertion, late presentation >12 h after symptom onset) Documentation of a patient reason (eg, initial patient concern with bleeding hazards) 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 In the ISIS-2 (Second International Study of Infarct Survival) trial,30 the fibrinolytic streptokinase significantly reduced 5-week vascular mortality by 2.8% compared to placebo, which remained significant at a median follow-up of 15 mo. 