PCI of a totally occluded infarct artery greater than 24 hours after STEMI should not be performed in asymptomatic patients with 1- or 2-vessel disease if patients are hemodynamically and electrically stable and do not have evidence of severe ischemia.418 420 (Level of Evidence: B) Studies and meta-analyses suggest potential benefit for PCI in fibrinolytic failure.385,386 In stable patients treated with fi- brinolytic therapy and clinical evidence for successful reper- fusion, an early invasive strategy with cardiac catheterization performed within 24 hours decreases reinfarction and recur- rent ischemic events.388,390,391 Table 10. 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). 