Transfer to a PCI-capable hospital for coronary an- giography is reasonable for patients with STEMI who have received fibrinolytic therapy even when hemodynamically stable and with clinical evidence of successful reperfusion. Angiography can be per- formed as soon as logistically feasible at the receiv- ing hospital, and ideally within 24 hours, but should not be performed within the first 2 to 3 hours after administration of fibrinolytic therapy.358 363 (Level of Evidence: B) 5.3.1.1. Transfer for Cardiogenic Shock The SHOCK (Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock) trial354 demonstrated benefit with coronary angiography and emergency revascu- larization (with either PCI or CABG) compared with imme- diate medical stabilization and delayed revascularization in patients with ST-elevation/Q-wave or new LBBB MI and cardiogenic shock (Section 9.1.1). Of note, nearly 50% of patients randomized to the emergency revascularization arm received preprocedural fibrinolytic therapy, and the benefit of Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high- grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia. emergency revascularization was similar for patients trans- ferred versus those admitted directly to a PCI-capable hospital. For patients with cardiogenic shock, the benefit of emergency revascularization was apparent across a very wide time win- dow, extending up to 54 hours after MI and 18 hours after Although PCI should be performed as soon as possible after MI and shock onset, the time window for benefit in this clinical context is more prolonged because of the ongo- ing downward ischemic spiral associated with shock. 5.3.1.2. Transfer for Failure of Fibrinolytic Therapy Several trials in the stent era and several meta-analyses have examined the role of PCI for fibrinolytic failure346,355 357,364 (Online Data Supplement 4). 