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In 1993, Lincoff and Topol claimed that the thrombolytic treatment of ST-segment elevation myocardial infarction was suboptimal in many patients and gave an ‘illusion of reperfusion’. In this Perspective article, the authors propose that a similar illusion of revascularization exists for contemporary percutaneous revascularization in patients with coronary artery disease and ischaemia, and identify how outcomes might be improved.