The feasibility, safety and efficacy of performing left heart catheterization, coronary angiography, and intracoronary thrombolytic therapy in the coronary care unit setting were examined in 17 patients with acute ischemic syndromes presenting at a time when routine catheterization facilities were not available. In all cases, cardiac catheterization and coronary angiography were performed in the coronary care unit without difficulty using a portable image intensifier and a portable video recording system, and selective intracoronary streptokinase was safely administered in 13 patients with a total coronary occlusion, with successful thrombolysis in seven patients (54%). No adverse effects attributable to the performance of these procedures in the coronary care unit were observed. This approach might allow for a more prompt response and wider availability of intracoronary thrombolytic therapy for patients presenting with acute myocardial infarction.