However, if primary PCI cannot be performed in a timely manner (within FMC-to-device time] 90 min, including the inability to transfer the patient timely from a non PCI-capable to a PCI-capable hospital to achieve FMC-to-device time 120 min), timely fibrinolytic therapy (within DTN 30 min) is an acceptable alternative therapeutic strategy. On the other hand, if fibrinolytic therapy is contraindicated or if the complications of cardiogenic shock or acute severe heart failure ensue, primary PCI should be undertaken irrespective of the time delay from FMC or STEMI symptom onset. Clinical Recommendation(s) 2013 ACCF/AHA Guideline for the Management of Patients With ST-Elevation Myocardial Infarction12 1. Reperfusion therapy should be administered to all eligible patients with STEMI with symptom onset within the prior 12 hours.70,92 (Class I, Level of Evidence: A) 2. 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) 3. 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 I, Level of Evidence: B) 4. Immediate transfer to a PCI-capable hospital for primary PCI is the recommended triage strategy for patients with STEMI who initially arrive at or are transported to a non PCI-capable hospital, with an FMC-to-device time system goal of 120 minutes or less.*93,94,98,99 (Class I, Level of Evidence: B) 5. In the absence of contraindications, fibrinolytic therapy should be administered to patients with STEMI at non PCI-capable hospitals when the anticipated FMC-to-device time at a PCI-capable hospital exceeds 120 minutes because of unavoidable delays.70,74,75 (Class I, Level of Evidence: B) 6. 