Thrombolytic therapy has revolutionised the management of acute myocardial infarction (MI) and saved many thousands of lives. Since these agents first became available nearly 20 years ago, many new pharmacological therapies have been developed to try and improve both short-term and long-term outcome following MI. Surgical interventions too are being considered as a serious option during the immediate post-MI period to avoid the adverse effects of thrombolysis and improve long-term outcome. At the same time, research is focusing on what therapy should follow acute MI treatment to improve the long-term outlook for patients. Both old and new therapeutic options need to be considered to offer patients the best chance of a full recovery and long-term survival after MI.