The first scientific description of acute myocardial infarction (AMI) was published in 1912. Since then evolution of AMI management can be divided into 4 phase i.e. Phase 1- bed rest, Phase 2- coronary care unit, Phase 3- myocardial reperfusion and Phase 4- prevention of reperfusion injury and regeneration. In this chapter reperfusion therapy, adjunct anticoagulant therapy with thrombolysis, stem cell therapy is discussed along with Indian scenario and future directions. Reperfusion therapy can be achieved by angioplasty, thrombolysis or a combination of both (pharmacoinvasive strategy). Adjunct anticoagulant (heparin) therapy is recommended for at least 2 days after thrombolysis and preferably up to the discharge from the hospital. Prehospital assessment along with prehospital ECG helps in proper referral of patients to catheterization laboratory equipped hospital, early activation of response team and thus better AMI outcomes.