All patients with ongoing ST-segment elevation myocardial infarction (STE-MI) should undergo prompt reperfusion to salvage ischemic myocardium and improve survival. Primary percutaneous coronary intervention (PCI) is considered the treatment of choice with many advantages over fibrinolysis. However, it is sometimes, if it can be performed adequately and in a timely fashion, not available as quickly as necessary to achieve a better result than fibrinolysis. In patients with early presentation (within 2 to 3 hours from symptom onset), fibrinolysis may be a reasonable alternative to PCI, as in such cases the superiority of an invasive strategy is less evident. Fibrinolysis should be preferred in patients without contraindications, in whom the delay of primary PCI exceeds 90 minutes. The best strategy for STE-MI should be evaluated in each patient in relation to clinical and logistic parameters...