The management of acute myocardial infarction initially focused on treatment and/or prevention of complications. In the prethrombolytic era, therapeutic regimens mainly comprised the use of antianginal and antiarrhythmic drugs. The development of semi-invasive hemodynamically guided treatment concepts led to remarkable improvement in clinical outcome. After the introduction of the “wave-front phenomenon,” multiple pharmacologic treatment strategies were developed with the goal of infarct size reduction. The use of thrombolytic agents reduced infarct size and improved prognosis of patients with acute myocardial infarction. Acute angioplastic intervention was introduced in specialized centers to achieve rapid restoration of coronary blood flow. The protection of the myocardium from reperfusion injury, however, remains an unresolved issue. Intravenous magnesium administration in conjunction with new and better recanalization techniques could therefore be a promising therapy strategy in patients with acute myocardial infarction.