Late patency of the infarct-related artery has been shown to be associated with improved long-term survival rates in observational cohort studies. However, there is a dearth of randomized trials correlating the opening of persistently occluded infarct-related arteries with clinical outcomes. Recent technological advances have improved the success and safety of percutaneous revascularization, resulting in lower restenosis and reocclusion rates. A large randomized trial is needed to evaluate clinical outcomes with percutaneous revascularization versus medical management of occluded infarct-related arteries in the absence of inducible ischemia.