For the patient with acute myocardial infarction (MI), both primary percutaneous transluminal coronary angioplasty (PTCA) and intravenous thrombolytic therapy are effective in restoring antegrade coronary blood flow, improving left ventricular systolic function, and reducing mortality. Primary PTCA is effective when performed quickly by experienced operators. It is the preferred therapy in the patient a) with a contraindication to thrombolytic therapy, b) aged 70 years or older, and c) in whom thrombolytic therapy is likely to be ineffective (ie, the patient with cardiogenic shock). Thrombolytic therapy is widely available and can be given quickly and easily. As a result, it remains the treatment of choice for most patients with acute MI. The goal of therapy for the patient with acute MI is the rapid and sustained restoration of coronary blood flow. For the individual patient, the better therapy-primary PTCA or thrombolytic therapy-is the one that can be given more safely and expeditiously.