Patients with advanced chronic kidney disease sustain extremely high mortality rates following acute myocardial infarction. Nauta et al. evaluated temporal trends in 12,087 patients with acute myocardial infarction from a single institution over 24 years and report a reduction in 30-day mortality in the most recent decade for all patients, including patients with chronic kidney disease. This trend is optimistic, but understanding contributory factors would be critical in future studies to further improve survival.