Primary infarct artery stenting has the potential to advance treatment of acute myocardial infarction. The postulated mechanisms of the benefit of stenting in acute myocardial infarction are the achievement of an acute optimal angiographic result and correction of any residual dissection to decrease the incidence of early and late restenosis and reocclusion and of the correlated events such as fatal and nonfatal reinfarction and repeat target vessel revascularization for recurrent ischemia. The results of 5 completed randomized trials comparing primary stenting with primary percutaneous transluminal coronary angioplasty show a lower incidence of the composite end point of death, myocardial infarction, and repeat target vessel revascularization in the stent groups as compared with the angioplasty groups and support the more extensive use of stents in patients with acute myocardial infarction. The efforts of the next years will be focused on further refinement of stent design and composition and the evaluation of pharmacological agents effective in restoring myocardial reperfusion to the fullest extent.