OBJECTIVES: To determine the success and survival rate of patients undergoing rescue angioplasty in failed thrombolysis in acute myocardial infarction, in the private practice setting of a tertiary care community hospital. METHODS: Between January 1990, and March 1995 we treated 125 patients with rescue angioplasty after failed thrombolysis for acute myocardial infarction. All patients were brought to the catheterization laboratory and studied if there was no evidence of reperfusion, and rescue angioplasty was performed if the infarct related artery showed TIMI 0Ð1 flow. Their records were reviewed for the results of the angioplasty, presence of congestive heart failure, and survival during the hospitalization. RESULTS: One hundred and one men and 24 women (ages 21 to 79) were studied, of whom 48 had anterior infarcts, 8 lateral infarcts, and 69 inferior infarcts. Of the 109 patients with successful procedures (87.2%) three died (2.8%). Of the 16 patients with failed procedures, six (37.5%) died (p = 0.00011). Eight of the nine patients who died were in extremis upon entering, or soon after entering the hospital, and would have been expected to die. However, one patient initially successfully recanalized and stabilized, rapidly deteriorated and died when his artery reoccluded and could not be reopened. Patients with congestive heart failure, documented by x-ray, had a higher mortality rate (21.1%) than patients who were free of failure (3.3%, p = 0.017). CONCLUSION: Patients who have a successful rescue angioplasty after failed thrombolysis in acute myocardial infarction have a higher survival rate than those who fail a rescue procedure. Most patients who die are in extremis upon admission.