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. In that trial, the combination of streptokinase and aspirin was also associated with significantly fewer reinfarction, stroke, and death events compared to placebo.30 The benefits of acute reperfusion with fibrinolytic therapy in patients with STEMI was further corroborated by the report from the Fibrinolytic Therapy Trialists, which included nine trials randomizing a total of 58600 patients to fibrinolytic therapy versus control.70 The aforementioned collaborative report also demonstrated an inverse relation between the benefit from fibrinolytic therapy and delay from symptom onset, with highly significant absolute mortality reductions of 3% for patients presenting within 0 to 6 h and 2% for those presenting 7 to 12 h from symptom onset.70 The ACCF/AHA guideline for the management of STEMI12 recommends that patients who present with STEMI to a non PCI-capable hospital should receive timely fibrinolytic therapy, if interhospital timely transfer time for primary PCI is not feasible (to achieve mechanical reperfusion within 120 min of FMC). 