Background: Fibrinolytic therapy restores patency of infarct related artery in about half of patients with STEMI. This study was designed to evaluate 6 months outcome after rescue PCI. Methods: Sixty patients with STEMI were included in this controlled, prospective study. All patients had fibrinolytic therapy at baseline and had failed fibrinolysis detected by ECG and or persistence of chest pain. 50% of patients had rescue PCI and the others were treated conservatively. 30 days and 6 months major adverse cardiovascular events (MACE) were reported. Results: After 30 days, angina required hospitalization was reported in 30% vs 7% in conservation and rescue groups (P=0.01). Target vessel revascularization was higher in conservative group (13%) than rescue group (0%), (P=0.02). The 6 months follow up showed no motility benefit. However, re-hospitalization due to ACS and target vessel revascularization were more in the conservative group than rescue group, 40% vs 13%, 30% vs 1% respectively (P=0.02). Heart failure and re-infarction showed no significant difference between both groups. The mean LVEF vas higher in rescue PCI patients (60±7% vs 45±8%) (P=0.001). Conclusion: Rescue PCI is safe, feasible and effective treatment option for patients with failed thrombolytic therapy.