International studies (TAMI, TIMI II A, TIMI II B, European Cooperative Study, DANAMI, GUSTO, LATE, SWIFT, SAVE) confirmed the concept of coronary balloon angioplasty (PTCA) after acute myocardial infarction to be reduced to strict indications. These strict indications are on the one hand side based on anatomically suited coronary lesions, on the other hand side dependent on ischemia and/or angina. Direct (immediate) PTCA, rescue PTCA in evolving infarctions after failing lytic therapy are recommended, if operators and a well-trained team are available on a 24 hours basis. Routine PTCA after myocardial infarction is not save enough any time after myocardial infarction with or without lysis, therefore "watchful waiting" (Braunwald) still is recommended. But ischemia also depends on how much you look for it! The state of total occluded vessels, significant stenoses without ischemia, the elderly, non Q-wave infarctions, reduced left ventricular function are a field of discussion and patients with these findings should rather undergo angioplasty and PTCA, as long as we have no other detailed results from ongoing studies.