The use of sonothrombolysis — the delivery of high mechanical index impulses from a diagnostic ultrasound transducer during an intravenous microbubble infusion — improves outcomes after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI), according to data from the MRUSMI trial presented at ACC.19. Patients with a first STEMI were randomly assigned to receive sonothrombolysis before and after PCI or to undergo PCI only (n = 50 in each group). Compared with PCI only, the addition of sonothrombolysis was associated with increased rates of ST-segment resolution and improved angiographic recanalization before PCI. Moreover, infarct size at hospital discharge was decreased, left ventricular ejection fraction after PCI was increased and the need for defibrillator implantation was reduced with sonothrombolysis compared with PCI only.