Indications for PCI in STEMI Indications COR LOE References Primary PCI* STEMI symptoms within 12 h I A 379 382 Severe heart failure or cardiogenic shock I B 383,384 Contraindications to fibrinolytic therapy with ischemic symptoms 12 h I B 399,400 Clinical and/or electrocardiographic evidence of ongoing ischemia between 12 and 24 h after symptom onset IIa B 401 403 Asymptomatic patients presenting between 12 and 24 h after symptom onset and higher risk IIb C N/A Noninfarct artery PCI at the time of primary PCI in patients without hemodynamic compromise III: Harm B 404 408 Delayed or elective PCI in patients with STEMI Clinical evidence for fibrinolytic failure or infarct artery reocclusion IIa B 385,386 Patent infarct artery 3 to 24 h after fibrinolytic therapy IIa B 390,391 Ischemia on noninvasive testing IIa B 410,411 Hemodynamically significant stenosis in a patent infarct artery 24 h after STEMI IIb B 413 417 Totally occluded infarct artery 24 h after STEMI in a hemodynamically stable asymptomatic patient without evidence of severe ischemia III: No Benefit B 418 420 *Systems goal of performing primary PCI within 90 min of first medical contact when the patient presents to a hospital with PCI capability394,395 (Class I; LOE: B) and within 120 min when the patient presents to a hospital without PCI capability396 398 (Class I; LOE: B). COR indicates class of recommendation; LOE, level of evidence; N/A, not applicable; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. 