Reperfusion therapy with intravenous thrombolytic agents in acute ST-segment elevation myocardial infarction reduces the infarct size, preserves ventricular function, and therefore reduces mortality. Experimental and clinical studies also showed that time to successful reperfusion is a critical determinant of survival. In this paper the importance of very early (pre-hospital) thrombolysis, its comparison with percutaneous interventional therapy and the feasibility in Turkey are discussed. Although primary coronary interventions are preferred in patients with ST-segment elevation myocardial infarction intravenous, early bolus thrombolysis in the pre-hospital stage provides a therapeutic option as good as primary angioplasty. Until necessary policy and technical substructure are completed cardiology centers should apply the most suitable reperfusion strategy according with the guidelines, feasibilities and their experience.