Reperfusion strategies for acute myocardial infarction (MI) have important limitations. As an adjunct to primary angioplasty or stenting, platelet glycoprotein IIb/IIIa inhibition with abciximab has been demonstrated to reduce significantly the incidence of acute ischemic events and improve microvascular tissue level reperfusion. For pharmacologic reperfusion, the combination of abciximab with half-dose fibrinolytic agents does not diminish short-term mortality compared with fibrinolytic monotherapy alone. However, combination reperfusion therapy is associated with lower rates of reinfarction and urgent revascularization procedures, although non-intracranial hemorrhage risk is increased. Strategies to merge combination pharmacotherapy optimally with mechanical revascularization during acute MI are under investigation.