When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be ad- ministered within 30 minutes of hospital arrival.*89 93 (Level of Evidence: B) Class IIa 1. Reperfusion therapy is reasonable for patients with STEMI and symptom onset within the prior 12 to 24 hours who have clinical and/or ECG evidence of on- going ischemia. Primary PCI is the preferred strat- egy in this population.81,94,95 (Level of Evidence: B) *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. Figure 2. Reperfusion therapy for patients with STEMI. The bold arrows and boxes are the preferred strategies. Performance of PCI is dictated by an anatomically appropriate culprit stenosis. *Patients with cardiogenic shock or severe heart failure initially seen at a non PCI-capable hospital should be transferred for cardiac catheterization and revascularization as soon as possible, irrespective of time delay from MI onset (Class I, LOE: B). Angiography and revascularization should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy. CABG indicates coronary artery bypass graft; DIDO, door-in door- out, FMC, first medical contact; LOE, Level of Evidence; MI, myocardial infarction; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. O Gara et al 2013 ACCF/AHA STEMI Guideline e371 3.4.1.1. Regional Systems of STEMI Care and Goals for Reperfusion Therapy Any regional medical system must seek to enable rapid rec- ognition and timely reperfusion of patients with STEMI. 