No field in medicine has undergone as much transformation as management of acute myocardial infarction. Gone are the days when patients were confined to beds for thirty days and masterly inactivity was the order of the day. Earlier emphasis was on controlling of arrhythmias with the introduction of monitoring, CCU and antiarrhythmics. Reduction is myocardial infarction size was the focus of attention fro the next decade. now the emphasis is onthe restoration of blood supply following the occlusion of infarct related artery. Blood supply can be restored both by thrombolytics and primary angioplasty. The aim is that the reperfusion should be restored at the earilest, it should be complete and sustained. An attempt has been made in this review to consider the merits, drmerits of both strategies and compare the two protocols in the light of present evidence.