Between September 1981 and May 1986, coronary angioplasty immediately after intracoronary thrombolysis was attempted in 115 patients with acute myocardial infarction. The present study describes our experience with this combined procedure. Primary success was achieved in 102 patients (89%). Before discharge, 79 of these patients agreed to be restudied angiographically. The infarct-related vessel was still patent in 71 patients (patency rate of 90%). Sequential left ventricular angiograms of quality sufficient to allow automated analysis were obtained in 58 patients. Global ejection fraction improved significantly from 52 +/- 10% to 55 +/- 9% (p = 0.01) from the acute to the chronic stage. In patients with anterior infarction, the increase in global ejection fraction was primarily the result of significant improvement of the regional myocardial function of the infarct zone. No significant changes in global and regional myocardial function could be seen in patients with inferior infarction. However, when patients in whom the infarct-related vessel was reoccluded at follow-up angiography are excluded from analysis, the global and regional myocardial function did improve significantly irrespective of the location of the infarct. Median clinical follow-up of 20 months (range 4 to 50) resulted in an overall mortality rate of 4%. Preservation of global and regional left ventricular function with a low mortality rate suggests that immediate coronary angioplasty after thrombolysis can be safely used to provide reperfusion in the setting of acute myocardial infarction and that this combined procedure may be the optimal mode of therapy. Further randomized studies are warranted to precisely define the role of coronary angioplasty in acute myocardial infarction.