In that trial, the combination of streptokinase and aspirin was also associated with significantly fewer reinfarction, stroke, and death events compared to placebo.30 The benefits of acute reperfusion with fibrinolytic therapy in patients with STEMI was further corroborated by the report from the Fibrinolytic Therapy Trialists, which included nine trials randomizing a total of 58600 patients to fibrinolytic therapy versus control.70 The aforementioned collaborative report also demonstrated an inverse relation between the benefit from fibrinolytic therapy and delay from symptom onset, with highly significant absolute mortality reductions of 3% for patients presenting within 0 to 6 h and 2% for those presenting 7 to 12 h from symptom onset.70 The ACCF/AHA guideline for the management of STEMI12 recommends that patients who present with STEMI to a non PCI-capable hospital should receive timely fibrinolytic therapy, if interhospital timely transfer time for primary PCI is not feasible (to achieve mechanical reperfusion within 120 min of FMC). Despite the lack of strong supporting evidence, the clinical consensus is also to consider fibrinolytic administration in symptomatic STEMI patients presenting >12 h after symptom onset with STEMI when PCI is not feasible and when there is a large myocardium at jeopardy or hemodynamic instability.12 The survival benefit observed with fibrinolytic agents is greatest when they are administered within the first 2 h after the onset of STEMI symptoms.71 73 As the length of time between patient s presentation and the delivery of fibrinolytic therapy (DTN time) increases, the benefit from therapy decreases and progressive increase in infarct size and reduction in LVEF ensue. 