ECG and clinical findings of anterior MI or inferior MI with right ventricular involvement or precordial ST-segment depression, as well as ongoing pain, usually predicts increased risk and the greatest potential benefit.392 Conversely, patients with symptom resolution, improving ST-segment elevation, or inferior MI localized to 3 ECG leads probably gain little benefit. In stable patients treated with fibrinolytic therapy and clinical evidence for successful reperfusion, an early invasive strategy with cardiac catheterization performed within 24 hours de- creases reinfarction and recurrent ischemic events.388,390,391 Be- cause of the associated increased bleeding risk, very early ( 2 to 3 hours) catheterization after administration of fibrinolytic ther- apy with intent to perform revascularization should be reserved for patients with evidence of failed fibrinolysis and significant myocardial jeopardy for whom immediate angiography and revascularization would be appropriate.393 5.2.2.2. Primary PCI of the Infarct Artery: Recommendations Class I 1. Primary PCI should be performed in patients within 12 hours of onset of STEMI.379 382 (Level of Evidence: A) 2. Primary PCI should be performed in patients with STEMI presenting to a hospital with PCI capability within 90 minutes of first medical contact as a systems goal.394,395 (Level of Evidence: B) 3. Primary PCI should be performed in patients with STEMI presenting to a hospital without PCI capa- bility within 120 minutes of first medical contact as a systems goal.396 398 (Level of Evidence: B) 4. Primary PCI should be performed in patients with STEMI who develop severe heart failure or cardio- genic shock and are suitable candidates for revascu- larization as soon as possible, irrespective of time delay.383,384 (Level of Evidence: B) 5. 