Results from many clinical trials have changed treatment strategies, but due to considerable selection caused by extensive inclusion- and exclusion criteria the results are only valid for smaller groups, while the majority of the patients still suffer from high mortality with conservative treatment. We have during eight years followed 933 patients with first myocardial infarction and found that the group who tolerated treatment with thrombolytic agents had a lower mortality than the rest. On the other hand, infarct patients are generally old, often with concomitant chronic diseases which affect mortality, and this in combination with heart-failure and cardiac arrhythmias determines outcome. Better prophylactic and treatment measures are needed to improve survival of ischaemic heart disease.