Background: Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy in patients withST segment elevation myocardial infarction (STEMI) within 12 h of symptom onset, provided it can be performed expeditiously (i.e. 120 min from STEMI diagnosis, by an experienced team. An experienced team includes not only interventional cardiologists but also skilled support staff. Objective: This study aimed to assess the early and 6-month outcomes of ST-elevation myocardial infarction patients according to the use of primary PCI and three different protocols of pharmaco-invasive reperfusion in the acute stage based on timing of PCI after thrombolytic therapy. Patients and Methods: This prospective cohort study was conducted in Cardiology Department, Zagazig University Hospitals and National Heart Institute. We included 104 consecutive patients with anterior STEMI, within a time period of six months from January 2021 to June 2021. Results: We found that group A patients had the lowest incidence of major adverse cardiacevents (MACE) (death, Maximal Killip class ≥II, severe and life-threatening bleeding) and highest median EF, Group B patients had almost similar MACE rates and 2nd high median LVEF, followed by group C with slightly impaired results, while Group D patients had the highest MACE rates and lowest median LVEF.  Conclusions: Our study showed that pharmaco-invasive strategy with early PCI after fibrinolysis within 24 hours constitutes a valid reperfusion strategy for patients presenting with ST elevation Myocardial infarction, where primary PCI was not feasible, and that the best acute stage and 6 month outcome is achieved with performance of early coronary angiography and intervention within 3-17 hours after fibrinolysis.