[Myocardial infarction 2009--Randomized studies vs. clinical daily routine].

Current national and international guidelines for patients with acute coronary syndromes mostly refer to the results of randomised clinical trials. However, these results usually include low-risk patients, while patients with higher risk, such as patients after resuscitation, with cardiogenic shoch or renal insufficiency are excluded. Therefore are the results of randomised trial not necessarily applicable to the every days clinical practice patients. This gap can be filled by prospective registries. Since the 1990 s such registries have been performed in Germany. In these registries we observed an increase in the rate of patients with early reperfusion therapy and an improvement in adjunctive therapy, which was associated with an improvement in prognosis. Registries certainly are not able to replace randomised trials, but can be useful to support results of randomized trials and to generate new hypothesis. Therefore prospective STEMI registries are an important part in the continuous effort to improve the care of patients with acute myocardial infarction.