Residual myocardial function has been shown by many investigators to be a key factor in determining survival following acute myocardial infarction. In light of this, much effort has been undertaken to develop means of preserving myocardium in the setting of acute myocardial infarction. Acute revascularization has been approached as a logical method to reach this end. The development of more effective thrombolytic agents, better catheter dilatation systems, and improved surgical techniques have now made acute intervention possible, safe, and practical. Because of the marked clinical variability of patient presentation, as well as variability of available medical and surgical resources, a rational and logical system of approach must be developed, such that patients presenting with acute myocardial infarction can receive the most appropriate interventional therapy in any given setting.