Because of the associated increased bleeding risk, very early (<2 to 3 hours) catheterization after administration of fibrinolytic therapy with intent to perform revascularization should be reserved for patients with evidence of failed fibrinolysis and significant myocardial jeopardy for whom rescue PCI would be appropriate. 6. Delayed Invasive Management 6.1. Coronary Angiography in Patients Who Initially Were Managed With Fibrinolytic Therapy or Who Did Not Receive Reperfusion: Recommendations See Table 9 for a summary of recommendations from this section. Class I 1. Cardiac catheterization and coronary angiography with intent to perform revascularization should be performed after STEMI in patients with any of the following: a. Cardiogenic shock or acute severe HF that devel- ops after initial presentation215,354,372,373 (Level of Evidence: B); b. Intermediate- or high-risk findings on predis- charge noninvasive ischemia testing232,233 (Level of Evidence: B); or c. Myocardial ischemia that is spontaneous or pro- voked by minimal exertion during hospitalization. (Level of Evidence: C) Class IIa 1. Coronary angiography with intent to perform revas- cularization is reasonable for patients with evidence of failed reperfusion or reocclusion after fibrinolytic therapy. Angiography can be performed as soon as (Level of Evidence: B) 2. Coronary angiography is reasonable before hospi- tal discharge in stable patients with STEMI after successful fibrinolytic therapy. Angiography can be performed as soon as logistically feasible, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrino- (Level of Evidence: B) The indications for coronary angiography in patients man- aged with an initial noninvasive strategy are interwoven with the indications for revascularization (Sections 5.3 and 6.2). Survivors of STEMI with indicators of intermediate or high risk and those with recurrent ischemia or mechanical compli- cations should be considered for coronary angiography and revascularization. 