Stemi is a clinical syndrome defined by characteristic symptoms of myocardial ischemia in association with persistent electrocardiographic (ECG) ST elevation and subsequent release of biomarkers of myocardial necrosis.Was to detect efficacy and predictors of outcomes of pharmacoinvasive treatment strategy in STEMI patients over reperfusion with thrombolysis only in areas with non-PCI capable centers as in most of hospitals in middle east. A time limited prospective interventional study started in November 2016 till November 2018. Patients divided into two groups, first group 300 patients treated with Lysis full dose TNK followed by risk stratification, the other 300 will go through pharmacoinvasive strategy as stream study by doing routine coronary angiography 3 to 24 hours after successful lysis, if lysis failed in both groups' patient will go directly to rescue PCI. Successful lysis is defined as > 50% regression of ST segment elevation with pain relief. Lysis associated with more myocardial damage, more Troponin release and less preservation of myocardial contractility function measured by Echo by EF. Pharmacoinvasive strategy significantly reduce risk of reinfarction, need for CABG, PCI, arrhythmia, preservation of EF and at least is as effective as 1ry PCI.