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. Continued 25 Short Title: PM-10: Door-in-Door-Out Time PM-10: Acute STEMI: Time From ED Arrival at STEMI Referral Facility to ED Discharge From STEMI Referral Facility in Patients Transferred for Primary PCI Measure Description: Percentage of patients, age 18 y, with acute STEMI, or its equivalent, whose median time from the ED arrival at STEMI referral facility to ED discharge from STEMI referral facility is 30 min. Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who are seen initially at a non PCI-capable hospital and who are transferred to a PCI-capable hospital within DIDO time 30 min *Patients with STEMI equivalent on ECG may have: hyperacute T-wave changes, true posterior MI, multilead ST depression with coexistent ST elevation in lead aVR, characteristic diagnostic criteria in the setting of LBBB. 