It is estimated that in the year 2025 more than 25 million people will die of cardiovascular disease (CVD) and approximately 11 million from acute myocardial infarction (MI) in a world population of approximately 7.9 billion. Approximately, 50% of these fatal MI deaths (>5 million) are sudden, within 1 hour. These deaths are caused by atheroma and subsequent thrombosis (atherothrombosis). Atheroma is the cause of fatal and nonfatal MI. Research must be directed at prevention of atheroma formation and progression. The thrombotic phase is late and researchers and interventional cardiologists are mainly engaged in strategies to define vulnerable atheroma plaques. Many investigative tools and testing are being developed to identify vulnerable plaques, and placement of stents can be done for a few wealthy individuals; a spit in the ocean, expecting the tide to rise. This chapter covers the postinfarction randomized control trials, triggers for atheroma and acute MI, diagnosis, treatment therapy, intracranial hemorrhage, Non-ST-segment elevation MI, and new concepts for prevention of fatal MI or sudden death.