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. Primary PCI should be performed as soon as possi- ble in patients with STEMI and contraindications to fibrinolytic therapy with ischemic symptoms for less than 12 hours.399,400 (Level of Evidence: B) Class IIa 1. Primary PCI is reasonable in patients with STEMI if there is clinical and/or electrocardiographic evi- dence of ongoing ischemia between 12 and 24 hours after symptom onset.401 403 (Level of Evidence: B) Class IIb 1. Primary PCI might be considered in asymptomatic patients with STEMI and higher risk presenting between 12 and 24 hours after symptom onset. (Level of Evidence: C) Class III: HARM 1. PCI should not be performed in a noninfarct artery at the time of primary PCI in patients with STEMI without hemodynamic compromise.404 408 (Level of Evidence: B) Primary PCI is preferred to fibrinolytic therapy when time- to-treatment delays are short and the patient presents to a high-volume, well-equipped center staffed with expert inter- ventional cardiologists and skilled support staff. Compared with fibrinolytic therapy in RCTs, primary PCI produces higher rates for infarct artery patency, TIMI flow grade 3, and Table 9. 