Background: Myocardial reperfusion with rapid recanalization of infarct-related artery is the key to success in the management of ST-elevation myocardial infarction (STEMI). Timely reperfusion is crucial for minimization of infarct size and thereby for preservation of left ventricular function and reduction in mortality in STEMI patients. Objective: The aim of this study was to determine the effectiveness of early routine percutaneous coronary intervention (PCI) post-fibrinolysis for ST-elevation myocardial infarction (STEMI) in relation to baseline risk status (assessed by GRACE score). Patients and methods: Our study was conducted on 120 patients presented with ST-elevation myocardial infarction who presented within 12 hours after the onset of symptoms to our hospital and were eligible for firbrinolytic therapy. Results: In general pharmaco-invasive strategy was associated with reduction of death, reinfarction, revascularization and composite MACE at 1 & 6 months follow up. In the subgroup analysis of the high risk patients who underwent routine early PCI, the reduction in improvement was associated with using BMS. Moreover, patients treated with BMS showed higher rate of revascularization than those treated with conservative strategy. The patients treated with DES showed reduction in re-infarction, revascularization and composite MACE within 6 months. The using of BMS versus DES in the non-high risk group didn't show significant difference on 6 months follow up. Conclusion: The baseline risk stratification will add advantage in choosing the strategy of reperfusion and even the type of stent used during PCI.