Background: Primary percutaneous coronary intervention (PPCI) is currently the cornerstone of management in patients with ST-segment elevation myocardial infarction (STEMI). Aim of the work: comparison between the efficacies of intracoronary nitroglycerin (NTG) versus nitroglycerin plus glycoprotein inhibitors (GP) IIb/IIIa for treatment of patients with thrombolysis in myocardial infarction flow less than three during primary percutaneous coronary intervention. Patients and methods: we prospectively enrolled 30 patients with STEMI undergoing PPCI randomized to receive IC NTG only (n = 15) versus NTG plus GP IIb/IIIa inhibitors (n = 15) during PPCI. The primary outcome was the incidence of angiographic MVO as defined by thrombolysis in myocardial infarction flow less than 3 or thrombolysis in myocardial infarction flow 3 with myocardial blush grade less than 2. Results: NTG plus GP IIb/IIIa inhibitors were associated with better primary outcome compared to NTG only TIMI 3 & MBG > = 2 (40%vs 73.3%, respectively; P = 0.036). There was a trend towards improved left ventricular ejection fraction with NTG plus GP IIb/IIIa inhibitors (44.33 ± 9.76 vs 52.87 ± 11.23, respectively; P = 0.035). In addition, NTG plus GP IIb/IIIa inhibitors was associated with lower incidence of 30-day major adverse cardiovascular events (26.7 vs. 66.7% respectively; P = 0.028). Conclusion: In PPCI, NTG plus GP IIb/IIIa inhibitors resulted in significant improvements in no-reflow and MVO with a better safety profile compared to NTG only. Larger trials should be conducted to confirm these results.