The primary goal of therapy for acute myocardial infarction is rapid, complete and sustained restoration of infarct-related artery (IRA) blood flow. Both fibrinolytic and mechanical restoration of anterograde coronary blood flow in patients have shown to improve left ventricular function, reduce infarct size and reduce mortality (1). The benefits of myocardial reperfusion, including prevention of infarct expansion, reduction of ventricular remodeling and improvement of electrical stability, are amplified when IRA patency can be achieved quickly after the onset of symptoms, particularly in the first 2 hours—a time window that is particularly challenging for mechanical methods of reperfusion. The Global Use of Strategies to Open Occluded Arteries trial (GUSTO-I) (2) correlated 90-min patency of the IRA with mortality reduction, and the Thrombolysis in Myocardial Infarction (TIMI-I) trial (3) showed that regardless of the fibrinolytic agent used, an occluded IRA (TIMI flow grade 0 or 1) at 90 min was associated with an 8.9% 30-day mortality rate, and normal flow (TIMI 3) with a 4% mortality rate. Those with partial perfusion (TIMI flow grade 2) had an intermediate mortality rate of 7.4%. Although intravenous fibrinolytic therapy is effective in improving outcome after a myocardial infarction and can be administered early to a greater proportion of patients than is possible with percutaneous coronary intervention, its “effectiveness profile” is disappointing to most cardiologists. There is a failure to lyse occlusive thrombi in a quarter of patients; reocclusion occurs in 10% of patients; and incomplete reperfusion is present in 30% (4- 5). Also, some patients have contraindications to this treatment. This is particularly true in the elderly, in whom stroke rates are high, but the potential benefit of reperfusion is greatest. Consequently, primary angioplasty has been adopted by many cardiologists, where facilities exist, as a preferred means of reperfusion.