The clinical, in-hospital and mid-term (14 +/- 12 months), results of primary percutaneous coronary angioplasty (PTCA) were investigated in 74 consecutive patients (pts) with acute myocardial infarction excluded from thrombolysis, of whom 9 pts with cardiogenic shock. In pts without cardiogenic shock at admission, the success rate of primary PTCA was high (92.3%) and the in-hospital mortality was low (3%). There were 89.2% asymptomatic pts during the in-hospital period. During the mid-term follow-up, pts without cardiogenic shock at admission had a mortality of only 4%, 66% of them remained asymptomatic, 24% developed angina pectoris and 6% had a new myocardial infarction. In pts with cardiogenic shock at admission to the hospital, the success rate of primary PTCA was of only 55.5% and the in-hospital mortality was high, 77.7%. In conclusion, primary PTCA in acute myocardial infarction excluded from thrombolysis is particularly useful in patients without cardiogenic shock.