Permissions: Multiple copies, modification, alteration, enhancement, and/or distribution of this document are not permitted without the express permission of the American Heart Association. Instructions for obtaining permission are located at http://www.heart.org/HEARTORG/General/Copyright-Permission- Guidelines_UCM_300404_Article.jsp. A link to the Copyright Permissions Request Form appears on the right side of the page. 2012 by the American College of Cardiology Foundation and the American Heart Association, Inc. O Gara et al 2013 ACCF/AHA STEMI Guideline e363 Table of Contents Preamble e364 1. Introduction e366 1.1. Methodology and Evidence Review e366 1.2. Organization of the Writing Committee e367 1.3. Document Review and Approval e367 2. Background e367 2.1. Definition and Diagnosis e367 2.2. Epidemiology e367 2.3. Early Risk Assessment e369 3. Onset of MI e369 3.1. Patient-Related Delays and Initial Treatment e369 3.2. Mode of Transport to the Hospital e369 3.3. Patient Education e369 Community Preparedness and System Goals for Reperfusion Therapy e370 Regional Systems of STEMI Care, Reperfusion Therapy, and Time-to- Treatment Goals: Recommendations e370 Regional Systems of STEMI Care and Goals for Reperfusion Therapy e371 Strategies for Shortening Door-to-Device Times e372 3.5. Prehospital Fibrinolytic Therapy e373 The Relationship Between Sudden Cardiac Death and STEMI e373 Evaluation and Management of Patients With STEMI and Out-of- Hospital Cardiac Arrest: Recommendations e373 4. Reperfusion at a PCI-Capable Hospital e374 4.1. Primary PCI e374 Primary PCI in STEMI: Recommendations e374 4.2. Aspiration Thrombectomy: Recommendation e375 4.3. Use of Stents in Primary PCI e375 Use of Stents in Patients With STEMI: Recommendations e375 4.4. Adjunctive Antithrombotic Therapy for Primary PCI e375 Antiplatelet Therapy to Support Primary PCI for STEMI: Recommendations e375 Anticoagulant Therapy to Support Primary PCI: Recommendations e378 5. 