For the critical outcome of 30-day mortality, we have identified very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 2 RCTs(Armstrong 2006, 1530-1538; Fernandez-Aviles 2007, 949-960) enrolling 337 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 0.84; 95% CI, 0.24–2.98) (Figure 11). For the critical outcome of 30-day mortality, we have also identified 1 non-RCT enrolling 1714 patients (Danchin 2008, 268-276) of very-low-quality evidence (downgraded for risk of bias and imprecision), showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 0.86; 95% CI, 0.48–1.55).For the critical outcome of intracranial hemorrhage, we have identified very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from the same 2 RCTs(Armstrong 2006, 1530-1538; Fernandez-Aviles 2007, 949-960) enrolling 337 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 3.14; 95% CI, 0.13–78.08). For the important outcome of reinfarction, we have identified very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from the same 2 RCTs(Armstrong 2006, 1530-1538; Fernandez-Aviles 2007, 949-960) enrolling 337 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 2.11; 95% CI, 0.51–8.64). For the important outcome of reinfarction, we also identified very-low-quality evidence (downgraded for risk of bias and imprecision) from 1 non-RCT enrolling 1714 patients (Danchin 2008, 268-276) showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 2.2; 95% CI, 0.73–6.61). For the important outcome of stroke, we have identified very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from the same 2 RCTs(Armstrong 2006, 1530-1538; Fernandez-Aviles 2007, 949-960) enrolling 416 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 0.96; 95% CI, 0.06–15.58). For the important outcome of stroke, we also identified 1 non RCT enrolling 1714 patients(Danchin 2008, 268-276) of very-low-quality evidence (downgraded for risk of bias and imprecision) showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 1.52; 95% CI, 0.41–5.67). For the important outcome of major bleeding, we have identified very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from the same 2 RCTs(Armstrong 2006, 1530-1538; Fernandez-Aviles 2007, 949-960) enrolling 337 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 1.33; 95% CI, 0.32–5.47). For the important outcome of major bleeding, we also identified very-low-quality evidence (downgraded for risk of bias and imprecision) from 1 non-RCT(Danchin 2008, 268-276) enrolling 1714 patients with STEMI showing no differential benefit of immediate in-hospital fibrinolysis and routine transfer for angiography compared with transfer to a PCI center (OR, 0.65; 95% CI, 0.26–1.63).