Detailed information about this program can be found on the AHA website.122 Several factors should be considered in selecting the type of reperfusion therapy (Figure 2). For patients with STEMI presenting to a PCI-capable hospital, primary PCI should be accomplished within 90 minutes. For patients presenting to a non PCI-capable hospital, rapid assessment of 1) the time from onset of symptoms, 2) the risk of complications related to STEMI, 3) the risk of bleeding with fibrinolysis, 4) the presence of shock or severe HF, and 5) the time required for transfer to a PCI-capable hospital must be made and a deci- sion about administration of fibrinolytic therapy reached. Even when interhospital transfer times are short, there may be relative advantages to a strategy of immediate fibrinolytic therapy versus any delay to primary PCI for eligible patients who present within the first 1 to 2 hours after symptom Several trials have suggested a benefit of transferring patients with STEMI from a non PCI-capable hospital to a PCI-capable hospital for primary PCI,83,125 but in many instances, transfer times are prolonged and delays may be unavoidable. In the NCDR,126,127 only 10% of transferred patients were treated within 90 minutes of initial presenta- tion, with a median first door-to-device time of 149 minutes. In many communities, a significant percentage of patients with STEMI who present initially to a non PCI-capable hos- pital cannot physically be transferred to a PCI-capable hos- pital and achieve an FMC-to-device time treatment goal of 90 minutes. 