Any comparison between intravenous and intracoronary thrombolysis must take into account such elements as the delays imposed by coronary arteriography, the extra cost of the procedure, etc., but ultimately the answer can only be provided by a controlled trial comparing the two approaches. To give truly significant results, this trial should fulfill several requirements concerning the time of randomization to treatments, the procedure to be followed in each group and the criteria of comparison. No such trial is available at present, so that the comparison can only rest on speculations and less demonstrative facts. As it stands, it is not in favour of intracoronary thrombolysis.