Rapid revascularization of every presenting patient is the goal of modern therapy of ST-elevation myocardial infarction (STEMI). With respect to the current situation at least one half of all these patients will be treated medically using thrombolysis, prehospital or in hospital. Invasive diagnosis and revascularization (percutaneous intervention [PCI], coronary artery to bypass graft [CABG]) should be done promptly. Primary PCI performed in a timely manner by experienced interventional cardiologists in specialized centers is the best option in the management of patients with STEMI. Transfer PCI is an effective method of treatment for patients initially admitted to a hospital without PCI facilities and should be completed within 90 minutes of transfer time. Rescue-PCI following unsuccessful thrombolysis (< 50 % ST-resolution 90 minutes post thrombolysis) improves prognosis by restoring coronary flow. If planned immediate PCI after thrombolytic therapy is not indicated, PCI immediately after high dosage of glycoprotein IIb/IIIa-Inhibitors in combination with a high dose of clopidogrel may give good results.