We are a Primary PCI Hospital and strive to get door to balloon times within 90 minutes of arrival for our STEMI Patients. We rarely ever administer fibrinolytics to our STEMI patients.  However, we receive patients that have received fibrinolytics at the referring facility either another primary hospital or a critical access hospital.  For those patients that have received a fibrinolytic our cardiologist looks at reperfusion (normalized EKG, pain free etc) and there may not be a need to rush to do the PCI.  If a change in the EKG or chest pain returns that then becomes an emergent trip to cath lab.  For those that arrive after receiving fibrinolytics and still have ST elevation and or chest pain they go emergently to the cath lab.  Why are these patients not a denominator exclusion for our hospital?  We didn't administer the medications so it is not appropriate for us to map to them and the time of administration is before the hospital ED arrival time so would not be captured.  Are these patients held to the PCI in 90 minutes of ED Arrival even if they received Fibrinolytic at the referring facility?