When there is no primary PCI available, there is ST elevation on the ECG and transfer to a primary PCI facility is not able to be done in a timely fashion (transfer in less than 60 minutes), fibrinolytic therapy is indicated.

The decision regarding primary PCI versus fibrinolytic therapy is important. Many major medical facilities have PCI capabilities since this is the treatment of choice for ST elevation myocardial infarction (STEMI). However, smaller hospitals or those located in rural areas may not. Those facilities frequently have capabilities to quickly transfer STEMI patients to a primary PCI facility.