Intravenous or intracoronary administration of glycoprotein IIB/IIIA inhibitors is fully justified in patients with massive intracoronary thrombus (IT). Several approaches of thrombus removal were examined, but the use of distal protection devices or mechanical thrombectomy is no longer recommended. Larger thrombus is correlated with higher mortality, worse immediate results of angioplasty and worse long-term outcomes. Patients with STEMI and visible thrombus in the culprit artery are predisposed to restenosis, peripheral embolism, slow-flow syndrome, no-reflow phenomenon and postprocedural heart failure. One of the causes of this condition is thrombus covering ruptured atherosclerotic plaque clearly seen in the coronary angiogram. Despite the great development in the interventional procedures, a large percentage of patients treated with percutaneous coronary intervention (PCI), has microcirculation impairment in the infarct area. The preferred method of treatment of patients with STEMI is the primary percutaneous angioplasty, which is aimed at restoration of a normal blood flow at the level of coronary microcirculation. Myocardial infarction survivors might have impaired left ventricle systolic function and they frequently develop overt heart failure or arrhythmia. Despite the tendency to reduce mortality observed in recent years, the number of deaths remains high. ST-segment elevation myocardial infarction (STEMI) is one of the leading causes of mortality and morbidity.
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