This paper is a short review of thrombolytic treatment of ST-segment elevation myocardial infarction with particular focus on pre-hospital thrombolysis. The paper is based on international publications within the field as well as on the authors' own experience. The effect of thrombolytic therapy following acute myocardial infarction is well documented, and a major advantage with this treatment is its ease of administration. Mechanical opening of acutely occluded coronary arteries by percutaneous coronary interventions (PCI) is, however, an alternative to thrombolytic therapy. Meta-analyses have demonstrated better outcome of PCI compared to thrombolytic therapy in patients with acute myocardial infarction admitted to invasive centres or being transported to such centres within a certain time frame. It is obvious, however, that the geographical conditions in Norway may limit the possibility for taking all patients to an invasive centre in acceptable time. In the absence of contraindications and if primary PCI cannot be performed within 90 min by an experienced team, pharmacological reperfusion should be initiated as soon as possible. In patients presenting late (6-12 h after symptom onset) PCI should always be considered due to less efficient thrombolysis in patients treated more than 6 h after symptom onset. A combined pre-hospital pharmacological and mechanical reperfusion strategy might prove to be beneficial and is currently under investigation. The time factor is essential for any method of revascularization, hence the possibility of offering pre-hospital thrombolytic therapy throughout Norway must be further developed.