During the last decade the treatment of patients with acute myocardial infarction (AMI) has changed dramatically. In order to evaluate the overall impact of these changes on mortality and morbidity, we collected data on all patients hospitalized for AMI in Reykjavik, Iceland, during the calendar years of 1986 and 1996. Demographical characteristics of AMI patients did not change significantly between study periods. One-year mortality decreased from 26.3 to 19.7% (p < 0.05). Patients discharged with aspirin or beta-antagonists as well as those who received thrombolytic therapy had decreased 1-year mortality both years. Patients discharged with diuretics, digoxin or antiarrhythmics had increased 1-year mortality. We conclude that the 25% reduction in 1-year mortality is partially due to changes in therapy.