Other attempts to estimate the time tradeoff between fibrinolysis and primary PCI suggest that the mortality benefit of primary PCI is lost if it is delayed by more than 60 min compared with a fibrin-specific lytic; when one adds the door-to-needle time of 30 min for a lytic, further support is found for the recommendation of a D2B time of 90 min (21- 22). Indeed, as suggested by Pinto et al. (23), the situation is much more complex than can be represented by a single number. Using a large dataset from NRMI (National Registry of Myocardial Infarction), Pinto et al. (23) showed that the equipoise point between primary PCI and a fibrinolytic may be as little as 40 min in a high-risk situation with much myocardium to salvage when one factors in the time from onset of symptoms, age of the patient, and location of the infarction (e.g., early presentation after the onset of infarction in a young patient with an anterior infarction); it may extend to 179 min in other situations (late presentation in an elderly patient with a nonanterior infarction) (23). These points emphasize, as stated in the preamble to STEMI clinical practice guidelines, that the recommendations put forward by writing committees are system goals but are not meant to supersede clinician judgment in individual cases.