Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. An angiotensin-converting enzyme inhibitor (ACE) should be administered within the first 24 hours to all patients with STEMI with anterior location, HF, or ejection fraction (EF) less than or equal to 0.40, unless contraindicated.59,63 65 (Class I, Level of Evidence: A) 2. An angiotensin receptor blocker (ARB) should be given to patients with STEMI who have indications for but are intolerant of ACE inhibitors.62,66 (Class I, Level of Evidence: B) 2014 AHA/ACC Guideline for the Management of Patients With Non ST-Elevation Acute Coronary Syndromes11 1. ACE inhibitors should be started and continued indefinitely in all patients with LVEF <0.40 and in those with hypertension, diabetes mellitus, or stable chronic kidney disease (CKD), unless contraindicated.67,68 (Class I, Level of Evidence: A) 2. ARBs are recommended in patients with HF or MI with LVEF less than 0.40 who are ACE inhibitor intolerant.62,69 (Class I, Level of Evidence: A) ACC indicates American College of Cardiology; ACCF, American College of Cardiology Foundation; ACEI, angiotensin-converting enzyme inhibitor; AHA, American Heart Association; AMI, acute myocardial infarction; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor; HF, heart failure; LV, left ventricular; LVEF, left ventricular ejection fraction; LVSD, left ventricular systolic dysfunction; LVSF, left ventricular systolic function; MI; myocardial infarction; and STEMI, ST-elevation myocardial infarction. Appendix A. Continued 22 Short Title: PM-7: Door-to-Needle Time PM-7: Acute STEMI: Time to Fibrinolytic Therapy Measure Description: Percentage of patients, age 18 y, with acute STEMI, or its equivalent, who receive fibrinolytic therapy (as the primary reperfusion modality) with a time from hospital arrival to fibrinolysis 30 min. 