The following National Heart Foundation of Australia (NHFA) guidelines are intended to assist physicians and other health-care providers in the appropriate management of patients presenting with acute myocardial infarction with ST elevation requiring reperfusion therapy. The guidelines describe the key elements required to obtain optimum reperfusion and outcome for an individual patient with myocardial infarction. They try to encompass most circumstances that apply (e.g. metropolitan and country) and give broad boundaries for practice. It is recognised that the treatment of the individual patient will vary depending on a number of factors, some patient related (e.g. age, blood pressure, type of infarct, previous treatments), and some place related (e.g. availability of hospital, angioplasty and bypass surgery). These guidelines are deliberately succinct and do not include all the classification of evidence. For a more detailed review of the evidence the reader is referred to the American College of Cardiology AHA Guidelines available on the web site of the American College of Cardiology (www.acc.org) and the American Heart Association (www.americanheart.org). Acute myocardial infarction (AMI) is usually caused by the complete occlusion of a coronary artery by thrombus secondary to the rupture of an atherosclerotic plaque. Studies have shown that prompt and sustained restoration of blood flow to the myocardium reduces mortality and other complications of AMI.1-4 In order to obtain optimum early treatment: the patient must recognise the symptoms of AMI and seek medical help; the correct diagnosis must be made by medical practitioners and the most appropriate reperfusion therapy must be chosen for a given patient.