Evidence is increasing that a patent culprit artery improves the prognosis of patients with acute myocardial infarction (AMI). Primary percutaneous transluminal coronary angioplasty (PTCA) has shown to be more effective than thrombolytic therapy alone. How effective is rescue PTCA after failed thrombolytic treatment? In a retrospective analysis, 176 consecutive patients with AMI and TIMI 0 or 1 perfusion grade were included. Patients had either rescue PTCA after failed thrombolysis (100 patients) or primary PTCA (76 patients). Angiographic data and in-hospital and 1-year outcome were analyzed. Comparison of baseline data of the two groups showed a higher proportion of long-standing angina and use of nitrates and aspirin in the primary PTCA group. Also, the delay between the onset of pain and PTCA was not significantly different, with a mean of 222 minutes for rescue PTCA and 245 minutes for primary PTCA (p = 0.52). The angiographic outcomes in the rescue PTCA group and the primary PTCA group were identical: The intervention was successful (TIMI 3 flow and residual stenosis <50%) in 86.0% and 85.5%, respectively. Complication rates of the procedure were also similar, except for bleeding complications. Blood transfusion was only needed after rescue PTCA in 3.0% versus 0.0% in primary PTCA patients. Clinical outcomes during hospital stay in terms of death rate (4.0% and 6.6%), reinfarction (6.0% and 3.9%), recurrent angina (16.0% and 11.8%), and repeat interventions were comparable, as was the first-year outcome. Failed PTCA was the most important predictor of a poor 1-year outcome; 28.0% died after failed PTCA versus 4.6% after successful PTCA (p < 0.001). In this retrospective analysis of 176 AMI patients, angiographic and clinical outcome, including a 1-year follow-up in patients who had rescue PTCA after failed thrombolysis, were of the same magnitude of patients in whom primary PTCA was performed. These findings suggest that in this subset the outcome of patients with rescue PTCA because of failed thrombolysis is good and is comparable with patients who underwent primary PTCA.