Acute myocardial infarction is a clinical cardiac emergency associated with potential and substantial morbidity and mortality. This disorder is triggered by an acute coronary syndrome caused by episodes of plaque ulceration, fissuration, or rupture with subsequent production of thrombogenic material and intravascular thrombus formation. The presence or absence of ST-segment elevation on the ECG defines the two main clinical spectrum of ST-segment elevation or non-ST-segment elevation myocardial infarction. In the last three decades, pharmacological and interventional management as well as in-hospital care have dramatically improved. Recent advances in antithrombotic strategies, percutaneous access (radial versus femoral), timing of revascularization, new generation coronary stents, lipid profile management, and cardiac rehabilitation programs at discharge have lead the European Task Force on ST-Elevation Myocardial Infarction to revise the 2012 guidelines and to release, in the current year, an updated version.