The article presents the new possibilities of preventing the onset of irreversible myocardial damage during ischemia and effective approaches undertaken in the early reperfusion period (per - and postconditioning of the myocardium) through coronary the introduction of cardioprotective drugs. Practitioners need medicines, which have fewer complications and are universal this is by far the metabolic drugs. The author surveyed 300 patients (three groups) with acute coronary syndrome (ACS) hospitalized no later than 4 hours from the beginning of anginal attack. Patients in group I (n=109) in the prehospital phase was carried out by the system tromboliticescoy therapy (TLT) in combination with intravenous etilmetilgidroksipiridina succinate (200 mg), which the hospital performed mechanical recanalization and angioplasty of the infarct-related coronary artery (IRA) with intracoronary introduction of etilmetilgidroksipiridina succinate (200 mg). Patients in group II (n=101) etilmetilgidroksipiridina succinate (200 mg) primary intracoronary injected during the endovascular procedure. Patients III (control) group (n=90) was carried out only angioplasty of the IRA. Conclusions: the effect of restoration of coronary circulation set after conducted thrombolytic therapy with intracoronary administration of etilmetilgidroksipiridina succinate immediately after successful angioplasty of the IRA, which helped to restore adequate blood flow to prevent relapses and extension of the necrosis zone, transition to a higher angina functional classes.