Two large stud- ies failed to show a net clinical benefit with this strategy.130,131 The term rescue PCI refers to the transfer for PCI of patients who demonstrate findings of failed reperfusion with fibrino- The term pharmacoinvasive strategy refers to the administration of fibrinolytic therapy either in the prehospital setting or at a non PCI-capable hospital, followed by immedi- ate transfer to a PCI-capable hospital for early coronary angi- ography and PCI when appropriate. Patients with STEMI who are best suited for immediate interhospital transfer for primary PCI without fibrinolysis are those patients who present with shock or other high-risk features, those with high bleeding risk with fibrinolytic therapy, and those who present >3 to 4 hours after symptom onset and who have short transfer times. Patients best suited for initial fibrinolytic therapy are those with low bleeding risk who present very early after symptom onset (<2 to 3 hours) to a non PCI-capable hospital and who have longer delay to PCI. Because patients with STEMI may first present with cardiac arrest, regional systems also should emphasize early access to care (recognition of the problem and bystander activation of EMS), rapid dispatch, bystander cardiopulmonary resuscita- tion(CPR),defibrillationwhenindicated,advancedcardiaclife support,andanorganizedapproachtopostresuscitationcare.In addition, family members of patients who have had STEMI or other manifestations of coronary artery disease should be referred to CPR training programs that have a social support component and can familiarize them with the use of auto- mated external defibrillators. 3.4.1.2. 