Systemic thrombolysis significantly reduces mortality in acute myocardial infarction if the treatment is administered rapidly after the first symptoms become manifest. To optimize utilization of this new treatment, patients should be accepted for thrombolysis if they can be admitted to a hospital with intensive care units within less than three hours of first clinical signs of acute myocardial infarction evidenced by electrocardiogram. The patients should undergo coronary angiography only if chest pain or ischemic ECG changes at rest or under exercise can be documented after thrombolysis or in young patients with large infarct. If this therapeutic revolution is exploited with care and selecting the best indications, the patient will benefit from improved management.