Cardiovascular disorders are the major cause of concern in India with estimated mortality reaching approximately 64 million by 2015. Though two major treatment options i.e. primary angioplasty (PAMI) and intravenous thrombolysis are available for the management of ST-elevation myocardial infarction (STEMI), primary angioplasty is not feasible for the majority of STEMI patients in India, hence early reperfusion therapy is critical for rapidly restoring coronary blood flow and limit further myocardial necrosis in these patients. Early/prehospital administration of thrombolytic agent results in a better outcome in STEMI. Reteplase, a third generation thrombolytic, because of the possibility of bolus administration provides this opportunity. In this review article, important clinical aspects regarding use of reteplase in the treatment of STEMI are summarized.