OBJECTIVE Acute ST-elevation myocardial infarction (STEMI) is a major cause of morbidity, mortality, and disability. This review summarizes recent advances in the treatment of patients with STEMI. RESULTS The best prehospital and interhospital transfer strategy for patients with STEMI is rapid transport to a percutaneous coronary intervention (PCI) center by Emergency Medical Services, with prehospital diagnosis and activation of the cardiac catheterization laboratory. Coronary angiography is now recommended for all patients with STEMI. Advances in adjunctive pharmacological and device therapy have improved primary PCI results. Thrombus aspiration, drug-eluting stents, systemic hypothermia for survivors of cardiac arrest with anoxic encephalopathy, and stem cells as reparative therapy have undergone recent evaluation. CONCLUSIONS Primary PCI with stent implantation as soon as possible is the best treatment strategy for patients with STEMI. Aspirin, bivalirudin, and either prasugrel or ticagrelor are the best antithrombotic agents to support primary PCI. Thrombus aspiration and intra-aortic balloon counterpulsation are important device adjuncts. Systemic hypothermia appears to be an important advance for survivors of cardiac arrest with anoxic encephalopathy, but the benefits of stem cell therapy have yet to be proven.