A previously healthy 63-year-old patient was admitted to our hospital with typical chest pain after hard work in the forest. He was treated by an emergency doctor with 5000 U heparin and 500 mg aspirin intravenously. The first ECG recording in the hospital showed ST-segment elevation in inferior and lateral leads. At the hospital, he was treated with 60 mg prasugrel additionally. An immediate coronary angiography was performed that revealed a high-grade stenosis (90%) in the middle part of the dominant right coronary artery with a TIMI flow III. The stenosis appeared to be the result of a thrombus adjacent to a ruptured plaque. We decided not to perform primary PCI but instead treated the patients with dual-antiplatelet therapy (ASS, prasugrel) and Integrilin for 1 day. The ST-segment elevation resolved within a couple of hours. The patient became totally free of chest pain shortly after the angiography. A control angiogram 12 h later showed less thrombus in the coronary artery. A ventriculogram showed a very slight contraction disturbance of the inferior wall of the left ventricle. The creatine kinase level rose to 240 U/L (norm <140 U/L). Before the patient was discharged after 6 days, another coronary angiogram was performed. The high-grade stenosis had almost totally disappeared. Left ventricular angiogram was normal. This case report shows that there are treatment options of STEMI beyond primary PCI or thrombolysis. Patients with STEMI and TIMI flow III can be treated effectively with dual-antiplatelet therapy, although this treatment option does not exist either in the 2008 ACC/AHA STEMI Performance Measures or in the current guidelines of the European Society of Cardiology.