Exploration of new strategies and therapies to improve survival and outcomes of acute myocardial infarction (AMI) continues. Recently published large clinical trials, including the long-term results from Grampian Region Early Anistreplase Trial, Global Use of Strategies to Open Occluded Coronary Arteries, and the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-)IIb angioplasty substudy, have helped to clarify the relative benefits of earlier treatment, the use of third-generation thrombolytic agents, and the use of primary angioplasty. Other, smaller trials such as Evaluation of c7E3 Fab in Preventing ischemic Complications of High-risk Angioplasty and intracoronary Stenting and Antithrombotic Regimen have stimulated thoughts about new adjunctive agents and devices, including platelet glycoprotein IIb/IIIa antagonists, primary stenting, and antioxidants. Both knowledge and therapies have advanced significantly in the past year, which should improve clinical outcomes of AMI in the near future.