Background: Until now there is no clear evidence to support the superiority of one strategy over the others to treat STEMI patients.Serial B‐type natriuretic peptide (BNP) measurements accurately predict the risk of death or congestive heart failure in STEMI patients. Objective: The aim of the study was to determine which strategy is the best strategy to treat acute STEMI and if BNP give an incremental prognostic value in treated STEMI patients.Patients presented with acute STEMI were enrolled in the present study. Patients and methods: Only 93 patients were followed up with us for 6 months and divided to 3 groups according to the treatment strategy. All patient underwent BNP analysis, echocardiography and treated with either received only thrombolytic therapy (Group I), primary PCI (Group II) or received thrombolytic therapy then went to catheterization (Group III). Results: Regarding BNP level change was higher in Group I and in Group III had high BNP level higher than Group II but this difference doesn`t reach level for statistically significant correlation between BNP levels and type of reperfusion in the three groups. Regarding LV systolic function, there was no statistically difference between the percent change in LV systolic function in Group I and Group III (P-value = 0.854, 0.152 respectively) but there was statistically significant difference between the percent change in LV systolic function in Group II (P-value=0.031). Conclusion: The best way for treatment of acute STEMI patients, is a primary PCI the most significant predictive methods are recovery of EF% and reduction of BNP, however pharmacoinavsive strategy like PCI strategy has good follow up prognosis and better than thrombolytic alone therapy.