Traditional, comparative acute myocardial infarction trials have used morbidity and mortality as endpoints, requiring large study populations. Left ventricular function and angiographic infarct-related artery patency have, therefore, been used as alternative endpoints. These assessments are costly, risk-laden, and put a large demand on resources not available in every hospital. This has led to an increased interest in noninvasive endpoints for comparative trials. This study describes the history and possibilities of ST-segment recovery analysis as an endpoint in acute myocardial infarction trials.