Percutaneous coronary revascularization of the „culprit“ lesion is the most contemporary method of treating patients with acute coronary syndrome (ACS) of all forms. In the management of acute ST-elevation myocardial infarction (STEMI), cardiac surgery remains, in most cases, a third option following PCI and thrombolysis, nevertheless serves an important role in a select subgroups of patients. This review will discuss current indications and potentiality of cardiac surgery in the treatment of patients with STEMI.