The role of coronary angiography in acute myocardial infarction is multifaceted. In the acute situation--for example, for primary angioplasty, suspected thrombolytic failure, or reocclusion--the goal of the angiographer should be therapeutic: to provide hemodynamic support, relieve ischemia, and interrupt the infarction process. In the nonacute or elective setting after infarction, the angiographer's goal should be to obtain diagnostic information only and not to approach the catheterization as a definitive therapeutic maneuver. This "uncoupling" of diagnostic angiography and revascularization is appropriate in light of the numerous trials discussed above. Either an invasive or a noninvasive approach to patient management can be justified with currently available data. The physician should not feel compelled to proceed with either approach necessarily. The patient's comfort level and the physician's comfort level with both approaches should be discussed by all concerned, when appropriate for the time constraints that exist with acute infarctions. Very likely, in the near future the two approaches, invasive and conservative, will undergo further analysis and modification as new agents and therapies become available.