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. Denominator All patients with acute STEMI and its equivalent Denominator Exclusions Patients age <18 y Patients who leave against medical advice shortly/immediately after arrival Patients who are on comfort care measures only or hospice documented on arrival Denominator Exceptions Documentation of a medical reason for not receiving reperfusion therapy (eg, active major bleeding, acute stroke, terminal illness/ futile culprit artery too small, no identifiable culprit or spontaneous reperfusion of the infarct artery without an obstructive lesion, severe CAD necessitating urgent/emergency CABG, attempted but unsuccessful PCI, late presentation >12 h after symptom onset) Measurement Period Encounter Sources of Data Medical record or other database (eg, administrative, clinical, registry) Attribution Measure reportable at the facility or provider level Care Setting Inpatient Rationale Overall, patients presenting with acute STEMI can undergo either pharmacologic (fibrinolytic therapy) or mechanical (primary angioplasty/PCI) reperfusion. Given its superiority to fibrinolytic therapy, the ACCF/AHA guideline for the management of STEMI12 outlines that primary PCI is the preferred treatment and should be performed timely in patients with acute STEMI. 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. 