Several reports have shown excellent outcomes for patients with STEMI undergoing interhospital transfer where first med- ical contact to-door balloon time modestly exceeded the sys- tematic goal of 90 minutes.396 398,409 In these reports, the referring hospital and the receiving hospital established a transfer protocol that minimized transfer delays, and out- comes were similar to those of direct-admission patients. On the basis of these results, the PCI and STEMI guideline writing committees have modified the first medical contact to-device time goal from 90 minutes to 120 minutes for interhospital transfer patients,397 while empha- sizing that systems should continue to strive for times 90 minutes. Hospitals that cannot meet these criteria should use fibrinolytic therapy as their primary reperfusion strategy. PCI of a noninfarct artery at the time of primary PCI in stable patients is associated with worse clinical outcomes unless the patient is in cardiogenic shock where PCI of a severe stenosis in a coronary artery supplying a large territory of myocardium might improve hemodynamic stabil- ity.404,406,408 Delayed PCI can be performed in noninfarct arteries at a later time if clinically indicated.410 412 5.2.2.3. Delayed or Elective PCI in Patients With STEMI: Recommendations Class IIa 1. PCI is reasonable in patients with STEMI and clinical evidence for fibrinolytic failure or infarct artery reocclusion.385,386 (Level of Evidence: B) 2. PCI is reasonable in patients with STEMI and a patent infarct artery 3 to 24 hours after fibrinolytic therapy.390,391 (Level of Evidence: B) 3. PCI is reasonable in patients with STEMI who demonstrate ischemia on noninvasive testing.410,411 (Level of Evidence: B) Class IIb 1. PCI of a hemodynamically significant stenosis in a patent infarct artery greater than 24 hours after STEMI may be considered as part of an invasive strategy.413 417 (Level of Evidence: B) Class III: NO BENEFIT 1. 