Even though primary PCI has been the first-line reperfusion strategy for patients with STEMI in the United States, the rate of fibrinolysis-focused reperfusion strategy remains about 2%-13% nationally.27Roe M.T. Messenger J.C. Weintraub W.S. et al.Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. During the COVID-19 pandemic, longer delays were reported to reperfusion. Tim and colleagues reported longer delays of symptom onset to first medical contact (318 vs 82.5 minutes), D2B time (110 vs 84.5 minutes), and catheterization laboratory to balloon time (33 vs 20.5 minutes) compared with the prepandemic era.28Tam C.F. Cheung K.S. Lam S. et al.Impact of coronavirus disease 2019 (COVID-19) outbreak on outcome of myocardial infarction in Hong Kong, China. Delayed presentation, lack of adequate COVID-19 testing early on, potential hazard to staff members, longer assessment times in emergency departments resulting in longer D2B times and therefore, potentially loss of primary PCI benefit, led to suggestions for a fibrinolytic-first approach in a selected patients with STEMI.29Welt F.G.P. Shah P.B. Aronow H.D. et al.Catheterization laboratory Considerations during the coronavirus (COVID-19) pandemic: from the ACC's interventional Council and SCAI. However, given the higher rate of no culprit including microthrombi with slow flow, stress-induced cardiomyopathy, COVID-19 induced myocarditis, or pericarditis, fibrinolysis may not only provide no benefit, but confer additional bleeding risk. With the adoption of enhanced safety measures in cardiac catheterization laboratories, greater access to rapid testing, and wider availability of personal protective equipment for staff, a joint recommendation from the ACC, SCAI, and American College of Emergency Physicians (ACEP) later recommended primary PCI for all patients with definite STEMI regardless of COVID-19 diagnosis.30Mahmud E. Dauerman H.L. Welt F.G.P. et al.Management of acute myocardial infarction during the COVID-19 pandemic: a Position Statement from the society for cardiovascular angiography and interventions (SCAI), the American College of Cardiology (ACC), and the American College of emergency Physicians (ACEP). Thrombolysis was instead recommended for patients with STEMI with severe COVID-19 pneumonia or those for whom transfer to PCI-capable hospital is not possible within 120 minutes from first medical contact.30Mahmud E. Dauerman H.L. Welt F.G.P. et al.Management of acute myocardial infarction during the COVID-19 pandemic: a Position Statement from the society for cardiovascular angiography and interventions (SCAI), the American College of Cardiology (ACC), and the American College of emergency Physicians (ACEP).,31Szerlip M. Anwaruddin S. Aronow H.D. et al.Considerations for cardiac catheterization laboratory procedures during the COVID-19 pandemic perspectives from the society for cardiovascular angiography and interventions emerging leader Mentorship (SCAI ELM) members and Graduates.