Acute myocardial infarction, the leading cause of death in western society, has been the focus of more randomized clinical trial effort over the past decade than any other area of medicine. As a result of this worldwide effort, involving hundreds of thousands of patients with myocardial infarction, data have accumulated showing substantially lower mortality of acute myocardial infarction with simple interventions such as IV thrombolytic therapy, aspirin, β-blockers, and angiotensin-converting enzyme inhibitors. Emergency coronary angioplasty appears to be a suitable alternative to IV thrombolytic therapy in skilled centers. Several previously recommended therapies (routine IV lidocaine, calcium channel blockers, magnesium, nitrates) have not been proved to be life-saving. Whether routine coronary arteriography should be employed after myocardial infarction remains controversial, but it is generally accepted that patients with evidence of residual ischemia after infarction, either spontaneous or provoked by stress testing, should undergo prophylactic coronary revascularization. © 1995.