Background: Early reperfusion therapy is necessary for ST-segment elevation myocardial infarction (STEMI), and it can be administered via either a pharmacoinvasive method or primary percutaneous coronary intervention (PPCI). Objective: The aim of the present study was to compare in hospital and 6 months follow up outcome when primary PCI is used to treat individuals with acute STEMI in PPCI capable center or transferred for PPCI when presented to non-PPCI capable center or treated by pharmacoinvasive strategy. Patients and methods: A total of 150 patients with acute STEMI were treated in a row. Each participant was subjected to laboratory investigation, transthoracic echocardiography and coronary angiography (CAG) with PCI was done for all patients. Three groups of patients were created, with 50 patients in Group I receiving treatment with emergency percutaneous coronary intervention in PPCI capable center. Group II included 50 patients were transferred for PPCI when presented to non-PPCI capable center and Group III included 50 patients was treated with pharmaco-invasive strategy when PPCI couldn't be done in a timely fashion. Results: The left ventricle (LV) and right ventricle (RV) function parameters improved following a 6-month follow-up. Across the 3 study groups, there was a very statistically significant difference in terms of average global longitudinal strain (GLS). All the 3 groups of patients showed improvement of LV systolic performance. As regard RV function parameters, it was improved in comparison with in hospital echo parameters with no significant difference as regard RV fractional area change (FAC) and RV S velocity among studied groups. Conclusion: Primary PCI is the strategy of choice for reperfusion of acute STEMI.