The impression I get from watching my friends who have kids at some of these elite schools. The schools who only pick the 'pointy' students are the top 5-10 schools in the country (less than 5% acceptance) not really the top 40-50. And it depends on the school what type of pointy they are looking for. For example MIT or Cal Tech want students who really stand out in math/science for some reason and win science completions. Stanford is known for accepting you if your an athlete that has prospects to make it to the Olympics.
To get into the top 40-50 schools students need that "EXCELLENT" package with the best GPA's (lots of AP's) and top SAT scores and do "general package" of expected volunteering/extracurriculars/music/athletics. The students I know that have gotten into top school, have chosen 2-3 extracurricular activities , do them all four years, and have leadership roles by the time they are seniors. For example band & Latin club where your the Latin club president & section leader in band your senior year. You don't necessarily need to stand out nationally. But you do need stand out in your own school.
