Information available about comparison between inferior wall myocardial infarction (MI) caused by RCA and LCX occlusion is limited. The aim of present study was to compare the difference between outcome of Left Circumflex artery and Right Coronary artery related acute inferior wall myocardial infarction undergoing emergency percutaneous coronary intervention. This prospective, observational, nonrandomized study enrolled 200 consecutive patients with inferior wall STEMI .The study was done at the National Heart Institute(NHI) and Benha university hospital (BUH),Cairo, Egypt in the period from January 2018 to March 2020.All patients were treated with emergency percutaneous coronary intervention during hospitalization and clinical characteristics and outcomes were compared .Group 1 included 100 patients presented with acute inferior wall STEMI caused by RCA occlusion and Group 2 included 100 patients presented with acute inferior wall STEMI caused by LCX occlusion .In –hospital mortality ,reinfarction, bleeding and stroke were reported in all patients.Total primary outcome in the present study was higher in LCX group(p=0.048) that may be related to higher use stents. Heart failure, stroke and bleeding were more than RCA group. More cardiac enzyme release in LCX group(p=0.046),also regard the 30 days outcome , the current study shows a higher incidence of combined end point of adverse cardiovascular events (Death and re-infarction) in LCX group compared to RCA group but not reaching statistically significance. Conclusions: The results of the current study suggest that LCX related acute inferior STEMI had an unfavorable clinical outcome after emergency PCI compared to RCA related acute inferior STEMI mostly related to relative increase in major or minor bleeding ,stroke and reinfarction.