In this multicenter trial, patients in whom thrombolytic therapy for acute myocardial infarction failed were randomly assigned to repeated thrombolysis, conservative therapy, or emergency percutaneous coronary intervention (rescue PCI). Event-free survival was better among patients assigned to rescue PCI. Patients in whom thrombolytic therapy for acute myocardial infarction failed were randomly assigned to repeated thrombolysis, conservative therapy, or emergency percutaneous coronary intervention. Event-free survival was better among patients assigned to rescue PCI. Patients who have an open infarct-related artery after acute myocardial infarction with ST-segment elevation have better clinical outcomes than patients without an open artery. 1 – 4 Although primary percutaneous coronary intervention (primary PCI) is a proven therapeutic approach in this setting 5 , 6 and is used increasingly, intravenous thrombolysis remains the first-line therapy in 30 to 70 percent of cases worldwide. 7 , 8 However, thrombolysis results in a grade 3 flow, according to the Thrombolysis in Myocardial Infarction (TIMI) classification system, in only 60 percent of patients, even with current fibrin-specific agents. 9 To date, it has been unclear how best to treat the . . .