To assess the utility of percutaneous transluminal coronary angioplasty after successful thrombolytic therapy for patients with acute myocardial infarction, the outcome of 201 patients who received intravenous recombinant tissue-type plasminogen activator (rt-PA) was analyzed. Reperfusion of the infarct-related artery was observed in 132 patients who were assessed for potential coronary angioplasty at 18 to 48 hours after treatment. Coronary angioplasty was performed in 52 patients (39%). Reasons for not performing angioplasty included unsuitable coronary anatomy, presence of residual stenosis of <60% and the need to perform an earlier procedure. When attempted, coronary angioplasty was successful in 96% of patients and was associated with a decrease in coronary stenosis from 85 to 30%. No patient experienced a major complication associated with coronary angioplasty. Of 36 patients undergoing predischarge coronary angiography after successful angioplasty, the infarct-related artery remained patent in 97.2%. Thus, coronary angioplasty is feasible and safe in patients who achieve coronary reperfusion after intravenous rt-PA for acute myocardial infarction. Not all patients who achieve reperfusion, however, are suitable for coronary angioplasty. When attempted, angioplasty is usually successful and associated with sustained patency of the infarct-related artery.