The current European and American Guidelines differ with regard to the recommended level for the use of routine early angiography after fibrinolysis for STEMI. Previous meta-analyses on randomized controlled trials have supported the routine early approach, but its advantage may be because of an excessively low angiography rate among patients in the non-routine strategy arm of the trials.We update the meta-analysis and apply meta-regression to evaluate whether the difference in outcome between the 2 randomized arms could be explained by the angiography rates in the non-routine strategy arm. Because reinfarction and recurrent ischemia are often the reported indication for angiography, we only use mortality endpoint in our meta-regression analysis.Among the eight trials included with 3195 patients, the angiography rate in the non-routine strategy arms ranges from 15% to 100%. The overall odds ratio for 30-day mortality comparing the routine early angiography arm vs the non-routine arm is 0.86 (95% confidence interval 0.60–1.24). On the plot listing the eight trials according to angiography rates, there is no visual trend in the odds ratio estimates for mortality when comparing the 2 treatment strategies as angiography rate decreases. In meta-regression analysis, angiography rate does not predict 30-day mortality (p=0.461).For STEMI, mortality endpoint trumps the softer endpoints of recurrent infarction and ischemia. The current study shows that the equipoise between the routine early invasive versus the non-routine strategy on 30-day mortality cannot be explained by the variable performance of angiography in the non-routine strategy arm.