Background: The opening of a related artery in myocardial infarction as quickly as possible is the key to treating infarct. Percutaneous coronary intervention (PCI) for recanalization of related infarcted arteries is considered the most effective therapy for myocardial infarction. Objective: To estimate the intracoronary delivery of glycoprotein IIb/IIIa following manual thrombus aspiration on outcomes post PCI for patients with high thrombus burden. Patients and Methods: This was a randomized control trial that was conducted on 48 patients presented to Zagazig University Hospital Emergency Cardiac Unit with ST elevation myocardial infarction for primary percutaneous coronary intervention, the need for reperfusion therapy was assessed according the European Society of Cardiology (ESC) Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation.Patients were randomized into three groups: (1) Manual aspiration group (16 patients). (2) Manual aspiration with intracoronary glycoprotein IIb/IIIa group (19 patients), and (3) Intracoronary glycoprotein IIb/IIIa group (13 patients). Results: There was significant difference between manual aspiration group, manual aspiration with intracoronary glycoprotein IIb/IIIa group and intracoronary glycoprotein IIb/IIIa group as regard the outcomes in high thrombus burden patients. Conclusion: Combination glycoprotein IIb/IIIa and manual aspiration is better then single modality for high thrombus burden patients.