Arrhythmic events are responsible for the majority of sudden cardiac deaths after myocardial infarction. Many clinical studies have suggested that patency of the infarct-related artery, achieved by thrombolytic therapy or revascularization procedures, is a predictor of survival rates irrespective of myocardial salvage. The open-artery hypothesis suggests that an open infarct-related artery may result in other potential mechanisms, of benefits including electrical stability. This review focuses on the various levels and types of evidence supporting this contention.