Background: Two-dimensional speckle-tracking echocardiography (2D STE) has been proven to be more accurate than prognostic metrics such as the left ventricular ejection fraction (LVEF) and wall motion score index (WMSI). Aim: To contrast the effectiveness of primary percutaneous coronary intervention (PCI) versus Streptokinase based pharmacoinvasive technique in ST elevation myocardial infarction (STEMI) patients. Patients and methods: In this observational cross section research, 100 patients with acute STEMI were enrolled. They were then divided into two groups: Group A, which included 50 patients who underwent primary PCI as a reperfusion strategy, and Group B, which included 50 patients who underwent pharmacoinvasive technique, which involved streptokinase IV infusion, over the course of a year from November 2020 to November 2021. In order to evaluate the main outcome, which was LV systolic function, all patients had a thorough medical history review, physical examination, 12-lead surface ECG, and echocardiogram (2D global longitudinal strain [GLS] utilizing speckle tracking echocardiography [STE]. Results: Pre-intervention GLS showed no statistically substantial variation between the two groups (p=0.768), however post-treatment GLS showed statistically substantial variations between the two groups (p=0.004) and regarding change (%) GLS (p˂ 0.001). Conclusion: Primary PCI remains the best option for resolving ischemia. When compared to IV streptokinase treatment, direct coronary angioplasty exhibited a substantial clinical advantage. To treat the myocardial infarction, it was superior to streptokinase based pharmacoinvasive therapy.