Direct PTCA is a treatment of choice in patients with acute myocardial infarction with ST segment elevations (STEMI). Fibrinolysis remains important modality of treatment in these patients. Currently, there are more then 100 tissue plasminogen activator mutants available with different fibrin specificity. In a clinical practice, tissue-type plasminogen activator (t-PA), recombinant tissue-type plasminogen activator (rt-PA), tenecteplase (TNK-tPA) and lanoteplase (n-PA) are most important examples. Fibrinolytic treatment in STEMI patients should be used in patients presenting in first 4 hours after beginning of chest pain, when it is sure, that direct PTCA cannot be started within next 90 minutes. Concomittant therapy of acute STEMI patients consists of anticoagulans, antiplatelet and antiagregatory treatment.