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. Fibrinolytic therapy should not be administered to patients with ST depression except when a true posterior (inferobasal) MI is suspected or when associated with ST elevation in lead aVR.70,84 87 (Class III, Level of Evidence: B) 5. In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI and cardiogenic shock who are unsuitable candidates for either PCI or CABG.70,88,89 (Class I, Level of Evidence: B) *The proposed time windows are system goals. For any individual patient, every effort should be made to provide reperfusion therapy as rapidly as possible. ACCF indicates American College of Cardiology Foundation; AHA, American Heart Association; CABG, coronary artery bypass graft; DTN, door-to-needle; ED, emergency department; FMC, first medical contact; LBBB, left bundle branch block; LVEF, left ventricular ejection fraction; MI, myocardial infarction; PCI, percutaneous coronary intervention; and STEMI, ST-elevation myocardial infarction. Appendix A. Continued 23 Short Title: PM-8: First Medical Contact-Device Time PM-8: Acute STEMI: Time to Primary PCI Measure Description: Percentage of patients, age 18 y, with acute STEMI, or its equivalent, who receive primary PCI during the hospital stay with a time from FMC-to-device time 90 min. Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, whose FMC-to-device time during primary PCI is 90 min *Patients with STEMI equivalent on ECG may have: hyperacute T-wave changes, true posterior MI, multilead ST depression with coexistent ST elevation in lead aVR, characteristic diagnostic criteria in the setting of LBBB. 