Considerable new evidence has accumulated in randomized trials of myocardial reperfusion. The trials of catheter-based reperfusion compared with fibrinolytics have shown an advantage for angioplasty and stenting over pharmacologic therapy, even accounting for delays in transporting patients from facilities with intervention capabilities. On the basis of the recent trials, it is recommended that a regional center for infarct intervention be set up akin to regional trauma centers in the United States. Now that we have entered the third decade of myocardial reperfusion therapy, we can expect iterative improvement in all aspects, and ultimately a fused approach of pharmacology and mechanical therapies-to achieve the optimal outcomes and continue to lower the toll of fatality and morbidity of acute myocardial infarction (MI).