The Strategies and Therapies for Reducing Ischemic and Vascular Events (STRIVE) acute coronary syndromes critical pathway toolkit has been revised again based on the 2007 focused update of the American College of Cardiology/American Heart (ACC/AHA) Association guidelines for the management of patients with ST-segment elevation myocardial infarction (STEMI). A previous update of the toolkit incorporated the 2007 ACC/AHA guidelines for unstable angina/non-ST-segment elevation myocardial infarction. This review highlights the major revisions to the STEMI guidelines, and illustrates and describes the revised STRIVE critical pathway tools for STEMI, which include pathway flowcharts, standing orders, pocket cards, and posters. The updated STEMI tools are available to clinicians online on the STRIVE Website.