Despite the lack of strong supporting evidence, the clinical consensus is also to consider fibrinolytic administration in symptomatic STEMI patients presenting >12 h after symptom onset with STEMI when PCI is not feasible and when there is a large myocardium at jeopardy or hemodynamic instability.12 The survival benefit observed with fibrinolytic agents is greatest when they are administered within the first 2 h after the onset of STEMI symptoms.71 73 As the length of time between patient s presentation and the delivery of fibrinolytic therapy (DTN time) increases, the benefit from therapy decreases and progressive increase in infarct size and reduction in LVEF ensue. Thus, the benefit of fibrinolytic therapy is most effective when provided promptly, and the ACCF/AHA guideline set a benchmark time goal from hospital arrival to drug administration, or DTN time, to be 30 min.12 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays.70,74,75 (Class I, Level of Evidence: B) 2. When fibrinolytic therapy is indicated or chosen as the primary reperfusion strategy, it should be administered within 30 minutes of hospital (Class I, Level of Evidence: B) 3. In the absence of contraindications, fibrinolytic therapy should be given to patients with STEMI and onset of ischemic symptoms within the previous 12 hours when it is anticipated that primary PCI cannot be performed within 120 minutes of FMC.30,70,79 83 (Class I, Level of Evidence: A) 4. 