Acute myocardial infarction (AMI) complicated by acute decompensated heart failure (ADHF) is not uncommon in real-world clinical practice (range 15.6–32.4 %) and the prognosis is known to be poorer than AMI patients without ADHF [ ]. The prognosis of ST elevation myocardial infarction (STEMI) with ADHF was similar to those of Non-ST elevation myocardial infarction (NSTEMI). Further, in-hospital mortality of NSTEMI complicated by ADHF was higher than those without ADHF [ ]. Although current guidelines regarding NSTEMI patients complicated by ADHF recommend immediate invasive strategy [ ]; however, there have not been enough convincing data supporting this recommendation to date. Particularly, there is lack of data regarding “optimal timing” of percutaneous coronary intervention (PCI) with current generation drug-eluting stent (DES) in this particular subset of patients. Thus, this report from COREA-AMI registry, a Korean multicenter observational cohort data has clinically important hypothesis-generating messages.