In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays.70,74,75 (Class I, Level of Evidence: B) 6. Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours duration.90 92 (Class I, Level of Evidence: A) 7. Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours duration who have contraindications to fibrinolytic therapy, irrespective of the time delay from FMC.100,101 (Class I, Level of Evidence: B) 8. Primary PCI should be performed in patients with STEMI and cardiogenic shock or acute severe HF, irrespective of time delay from MI onset.102 105 (Class I, Level of Evidence: B) 9. In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of FMC.30,70,79 83 (Class I, Level of Evidence: A) *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. ACCF indicates American College of Cardiology Foundation; AHA American Heart Association; CABG, coronary artery bypass graft; CAD, coronary artery disease; DTN, door-to-needle; EMS, emergency medical services; FMC, first medical contact; HF, heart failure; LBBB, left bundle branch block; MI, myocardial infarction; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. Appendix A. 