According to current guidelines [
17], to prevent stent thrombosis and/or recurrent myocardial infarction all patients are treated with dual antiplatelet therapy consisting of aspirin in combination with either clopidogrel, prasugrel or ticagrelor, usually for one year. Other durations, in particular shorter, as well as how to deal with patients with atrial fibrillation necessitating anticoagulant therapy are currently being studied. A tailored approach based on the balance of bleeding versus thrombotic risks may become the best option [
18]. Intravenous heparin is essential during acute PCI to prevent catheter thrombosis. A large number of additional pharmacological interventions have been studied to further improve clinical outcomes. New advances in antithrombotic therapy together with preventive measures after ST-segment elevation myocardial infarction (STEMI) have been studied extensively as the clinical syndrome is an acute thrombus-driven event. Oral antiplatelet agents such as aspirin and P2Y12 inhibitors like prasugrel, ticagrelor and intravenous antiplatelet agents (abciximab, eptifibatide and tirofiban), and intravenous anticoagulant agents (unfractionated heparin, low-molecular-weight heparin and bivalirudin) are the focus of research. Recently it was suggested that prasugrel might be more effective than other antiplatelet agents, without an increased bleeding risk [
19]. Furthermore, cangrelor, a rapid onset and potent intravenous P2Y12 inhibitor, became available but its role has yet to be determined [
20]. A personalised approach using genetic testing to adjust and guide antiplatelet therapy may further improve outcome especially in high-risk patients [
21]. Many antithrombotic regimens, gluco-metabolic interventions and a host of other pharmacological interventions have been studied, often with promising evidence in pre-clinical studies, but so far without consistent positive results in clinical settings. As preprocedural TIMI flow, before angioplasty, is a major determinant of survival, there is a need for pharmacological interventions, including thrombolytic therapy, either at home or in the ambulance, before cath-lab arrival. Optimal secondary prevention and rehabilitation are important for long-term outcome [
17].