Objective: To discuss some unresolved problems in myocardial ischemia/reperfusion research and to review some approaches for successfully combining adjuvant therapies with coronary artery opening. Method : The researches in myocardial ischemia/reperfusion in recent years were reviewed. Result: Reperfusion can produce significant salvage of ischemic myocardium. According to reports

the operation was carried out in 60-90 min for effective reperfusion and optimal myocardial salvage which conveys decreased short-term and long-term mortality compared with longer ischemic times. Reperfusion has negative effects on ischemic myocardium

which collectively are referred to as myocardial reperfusion injury

which complicates with arrhythmias

microcirculatory disturbances and progression to cell death of critically injured cardiomyocytes. Progressive unregulated remodeling is the important mortality in acute myocardial infarction. The development of clinical care systems that can routinely deliver very timely coronary opening and reperfusion

the limitation of myocardial reperfusion injury

the strategies to retard adverse remodeling are the difficult issues in reperfusion. Promising approaches are being explored including pre-conditioning and post-conditioning

activators of the reperfusion injury salvage kinase pathway and stem cell therapy. Conclusion : Myocardial reperfusion after ischemia is a double-bladed sword: the advantages mixed up with the problems. These challenges could be overcome by combining adjuvant therapies with reperfusion.