Early onset of cardiopulmonary resuscitation (CPR) and defibrillation are the most important factors for improving outcome after cardiac arrest. Many patients do not receive thrombolytic therapy after prolonged CPR, as there is a fear of serious bleeding complications. Ten patients with cardiac arrest and acute myocardial infarction were treated with primary angioplasty after prolonged CPR. Angioplasty was successful in nine of the patients, and left ventricular function was well preserved after six weeks. Primary angioplasty is highly effective and safe in establishing reperfusion in selected patients with acute myocardial infarction and cardiac arrest.