Background Although balloon angioplasty and stenting are effective in the treatment of acute myocardial infarction (M1), reduced coronary flow and distal embolization frequently complicate interventions when thrombus is present. Adjunctive treatment with mechanical thrombectomy devices was suggested to reduce these complications. Methods We evaluated immediate angiographic, in-hospital and 30-day follow-up clinical outcomes of 185 patients with acute MI and angiographically evident thrombus who were treated with Angiolet rheolytic thrombectomy followed by immediate definitive treatment. Results. Procedural success (residual diameter stenosis <50% and Thrombolysis in Myocardial Infarction [TIMI flow >2 after final treatment) was 97%. Rheolytic thrombectomy success was achieved in 7% of patients. Subsequent definitive treatment included stenting in 67% and balloon angioplasty alone in 26% of patients. Final TIMI 3 flow was achieved in 89%. Angiolet treatment resulted in mean thrombus area reduction from 69,6 mm(2) at baseline to 17,3 mm(2) post-thrombectomy (p<0,001). Procedural complications included distal embolization (7,6%) and perforation (1,1%). Clinical success (procedure success without major in-hospital cardiac events) rate was 88%, in-hospital mortality - 7,0%. There were no further major adverse events during 30-day follow-up. Conclusion. Rheolytic thrombectomy can be performed safely and effectively in patients with acute MI, allowing for immediate definitive treatment of thrombus-containing lesions.