Acute coronary syndromes with ST-segment elevation were known as acute myocardial infarction in the recent past. Their understanding and management are of paramount importance to achieve the earliest reperfusion treatment, using pharmacological (fibrinolysis) or mechanical therapeutics (percutaneous transluminal coronary angioplasty). New fibrinolytics and optimisation of antithrombotic regimen in association with coronary stents have dramatically reduced in-hospital mortality.