A strategy of immediate coronary angiography (or transfer for immediate coronary angiography) with intent to perform PCI is reasonable for patients with STEMI, a moderate to large area of myocardium at risk, and evidence of failed fibrinolysis.385,386 (Level of Evidence: B) 2. A strategy of coronary angiography (or transfer for coronary angiography) 3 to 24 hours after initiating fibrinolytic therapy with intent to perform PCI is reasonable for hemodynamically stable patients with STEMI and evidence for successful fibrinolysis when angiography and revascularization can be per- formed as soon as logistically feasible in this time frame.387 391 (Level of Evidence: A) Class IIb 1. A strategy of coronary angiography performed be- fore hospital discharge might be reasonable in stable patients with STEMI who did not undergo cardiac catheterization within 24 hours of STEMI onset. (Level of Evidence: C) Class III: NO BENEFIT 1. A strategy of coronary angiography with intent to perform PCI is not recommended in patients with STEMI in whom the risks of revascularization are likely to outweigh the benefits or when the patient or designee does not want invasive care. (Level of Evidence: C) The historical reperfusion strategies of primary PCI, imme- diate PCI, rescue PCI, deferred PCI, facilitated PCI, and the pharmacoinvasive strategy have evolved in parallel with advances in antithrombotic therapy and STEMI prehospital and hospital systems of care. The clinical challenge in primary PCI is achieving rapid time to treatment and increasing patient access to this preferred reperfusion strategy. The clinical challenge in patients treated with fibrinolytic therapy is deciding for whom and when to perform coronary angiography. In unstable patients (eg, severe heart failure or cardiogenic shock, hemodynamically compromising ventricular arrhyth- Table 8. 