Aim. To compare the safety and efficacy of pre-hospital thrombolysis with tenecteplase and hospital thrombolysis with alteplase. Material and Methods. Pre-hospital thrombolytic therapy with tenecteplase (n=15) and hospital thrombolysis with alteplaza (n=60) in patients with acute coronary syndrome and acute ST-segment elevation myocardial infarction were analyzed in retrospective comparative study. Time characteristics of thrombolysis and its efficacy and safety were assessed. Results. The mean time from patients emergency medical service call to pre-hospital thrombolysis was 51.8±1.23 min, whereas to hospital thrombolysis 106.5±2.15 min (p<0.05). The effective hospital thrombolysis was observed in 68.3 and 83.3% of patients according to ECG (>50% resolution of ST-segment elevation) and coronary angiography criteria, respectively. The effective pre-hospital thrombolysis was registered in 93.3% of patients as demonstrated with ECG and coronary angiography. Conclusion. Pre-hospital thrombolysis in patients with acute coronary syndrome was performed by 54.7 min earlier than hospital thrombolysis was. This can improve the patient prognosis.