PCI of an anatomically significant stenosis in the infarct artery should be performed in patients with suitable anatomy and any of the following: a. Cardiogenic shock or acute severe HF354 (Level of Evidence: B); b. Intermediate- or high-risk findings on predis- charge noninvasive ischemia testing232,233 (Level of Evidence: C); or c. Myocardial ischemia that is spontaneous or pro- voked by minimal exertion during hospitalization. (Level of Evidence: C) Table 9. Indications for Coronary Angiography in Patients Who Were Managed With Fibrinolytic Therapy or Who Did Not Receive Reperfusion Therapy COR LOE References Cardiogenic shock or acute severe HF that develops after initial presentation Intermediate- or high-risk findings on predischarge noninvasive ischemia testing Spontaneous or easily provoked myocardial ischemia I C N/A Failed reperfusion or reocclusion after fibrinolytic therapy IIa B 346, Stable* patients after successful fibrinolysis, before discharge and ideally between 3 and IIa B 358 363, *Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high-grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia. COR indicates Class of Recommendation; HF, heart failure; LOE, Level of Evidence; and N/A, not available. Although individual circumstances will vary, clinical stability is defined by the absence of low output, hypotension, persistent tachycardia, apparent shock, high- grade ventricular or symptomatic supraventricular tachyarrhythmias, and spontaneous recurrent ischemia. O Gara et al 2013 ACCF/AHA STEMI Guideline e385 Class IIa 1. Delayed PCI is reasonable in patients with STEMI and evidence of failed reperfusion or reocclusion after fibrinolytic therapy. PCI can be performed as soon as logistically feasible at the receiving hospi- (Level of Evidence: B) 2. Delayed PCI of a significant stenosis in a patent infarct artery is reasonable in stable patients with STEMI af- ter fibrinolytic therapy. 