Primary PCI is the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators.92 94 (Class I, Level of Evidence: A) 2. EMS transport directly to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI, with an ideal FMC-to-device time system goal of 90 minutes or less.*95 97 (Class 1, Level of Evidence: B) 3. Primary PCI should be performed in patients with STEMI and ischemic symptoms of less than 12 hours duration.90 92 (Class I, Level of Evidence: A) *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; ED, emergency department; EMS, emergency medical services; FMC, first medical contact; LBBB, left bundle branch block; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-elevation myocardial infarction; and TIMI, Thrombolysis in Myocardial Infarction. Appendix A. Continued 24 Short Title: PM-9: Reperfusion Therapy PM-9: Acute STEMI: Reperfusion Therapy Measure Description: Percentage of patients, age 18 y, with acute STEMI, or its equivalent, who receive fibrinolytic therapy or primary PCI. Numerator Patients with acute STEMI (or its equivalent*) defined by characteristic symptoms of myocardial ischemia with diagnostic ST elevation on ECG, who receive fibrinolytic therapy or primary PCI *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. 