Pivotal role of early and sustained infarct vessel patency in patients with acute myocardial infarction. Thrombolytic therapy in acute myocardial infarction unequivocally has improved short- and long-term mortality. The fundamental goal of therapy for evolving myocardial infarction is early and sustained infarct vessel recanalization. The mechanisms linking an open artery with improved long-term survival and other clinical outcomes are presented with use of data from extensive clinical trials. 