Acute myocardial infarction (AMI) has been associated with thrombotic occlusion of a coronary artery. Pharmacological thrombolysis restores coronary artery patency in about two-thirds of selected patients in the early hours of AMI. It is now evident that fresh thrombus represents the major pathologic finding in acutely occluded coronary artery, it is found in less than 70% of the cases.
A substantial proportion of AMI might be due to spontaneous dissection and or severe intramural hemorrhage and plaque rupture, in the context of preexisting coronary atherosclerosis. Resolution of overlying thrombus by thrombolysis may not be able to restore adequate antegrade flow in the affected artery. Mechanical repufusion appears to be necessary in at least a proportion of patients with AMI.
It has been shown that over 95% of patients presenting with AMI are acceptable candidates for primary angioplasty whereas up to one-third of cases are considered to have contraindication to thrombolysis. However, mechanical reperfusion with primary angioplasty and stenting achieves higher patency rates with less complications, especially in high risk patients.
The leading cause of death in patients hospitalized for AMI is cardiogenic shock and the efficacy of  thrombolysis is inadequate and mortality exceed 65% with treatment.
Prospective registries suggest that early revascularization should be strongly considered for patients with AMI complicated by cardiogenic shock.
Facilitated angioplasty using a combination of half-dose thrombolysis, platelet glycoprotein IIb/IIIa antagonists, and early intervention, appears to be a promising strategy for the treatment of AMI.
The efficacy and safety of this approach is currently under investigation.

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