AHA recommended that time from first medical contact to balloon should be within 120 minutes for transferred patients did not receive thrombolysis in primary hospital. The aim of this study was to evaluate the impact of reperfusion strategy recommendation by AHA on hospital outcomes for STEMI patients. We used the CArdioVAscular disease Surveillance (CAVAS) data from Nov 2008 to Dec 2012. Eligibility was the adult patients who diagnosed for STEMI and transferred from primary hospital for definite PCI. The patients who received PCI or CABG in primary hospital and arrived to primary hospital within 4 hours from symptom, time from door to balloon over 24 hours in definite hospital, and unknown ED disposition were excluded. Endpoint was hospital mortality. Main exposure was AHA recommendation for reperfusion therapy. Total of 1,799 patients were analyzed, 30.7% and 69.3% were in compliance and violation. Hospital mortality was 4.5% and 7.2% in compliance and violation (p-value 0.03). The crude odds ratio (95% CIs) of compliance group for hospital mortality was 0.61 (0.39-0.96) and adjusted odds ratio was 0.75 (0.46-1.21). In transferred STEMI patients, PCI care recommended by AHA was associated with lower mortality.