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The primary goal of reperfusion treatment in patients with ST-segment elevation myocardial infarction (STEMI) is to restore, quickly and permanently, infarct-related artery (IRA) patency. The achievement of complete peripheral flow (TIM1 grade 3 flow) improves short- and long-term prognosis. Primary percutaneous coronary interventions (PCI) show the highest efficacy in restoring infarct-related artery (IRA) patency, and are now the preferred treatment for patients with ST-segment elevation myocardial infarction (STEMI) with expected delay to invasive treatment < 90 min from a patient’s first contact with a physician. However, the need for a long distance transport to a hospital offering round-the-clock service by experienced operators limits access to primary PCI for many STEMI patients. Although recent data suggest that even a long transport improves outcomes with PCI rather than fibrinolysis at hospitals without invasive treatment capability, it is well established that markedly delayed initiation of reperfusion treatment from the onset of STEMI may increase the extent of myocardial injury and deteriorate prognosis. For this reason, in patients with STEMI and expected transportation time > 90 traditional fibrinolysis remains the method of choice. However, complete peripheral flow (TIM I grade 3 flow) is achieved in only 30-50% of patients depending on the fibrinolytic agent used. Furthermore, 5-10% ofthese patients experience reocclusion. Reinfarction after fibrinolysis markedly deteriorates prognosis. For this reason, facilitated PCI i.e. PCI after thrombolytic therapy to establish infarctrelated artery patency during transportation seems a viable alternative. This approach seems to fuse the best aspects of early thrombolysis and successful PCI in STEMI. Shortening time from pain onset to reperfusion and establishing IRA patency before PCI may improve clinical prognosis and better preserve left ventricular systolic function at long-term follow-up. On the other hand, there is a risk of bleeding complications in patients undergoing aggressive thrombolysis and ischemic complications of facilitated PCI.