Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who are seen initially at a non PCI-capable hospital and who are transferred to a PCI-capable hospital within DIDO time 30 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. Denominator All patients with acute STEMI, or its equivalent, who are seen initially at a non PCI-capable hospital and who are transferred to a PCI-capable hospital Denominator Exclusions Patients age <18 y Patients who are transferred for a PCI that is described as nonprimary treatment for AMI by a healthcare provider (eg, patients who receive fibrinolytic therapy as the primary reperfusion therapy) Denominator Exceptions Documentation of a medical reason for the delay (eg, cardiopulmonary arrest, balloon pump insertion, respiratory failure requiring intubation) Documentation of a patient reason for the delay (eg, initial concern, patient choice) Patient currently enrolled in a clinical trial related to AMI and reperfusion therapy Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility level Only STEMI referral facility (non PCI-capable facility) is accountable for this measure. Care Setting Inpatient Rationale Clinical trials have demonstrated improved outcome for patients with STEMI who are transferred to a primary PCI hospital in a timely manner. Current guidelines recommend that transfer occur immediately with an overall goal of FMC-to-device time of 120 min; this can be best achieved by shortening the time in the first ED and transferring the STEMI patient within DIDO of 30 min.20,98,99,106 Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. 