Background: Primary percutaneous coronary intervention (PCI) for ST- elevation myocardial infarction (STEMI) remains the default strategy. However, when primary PCI cannot be performed expeditiously, a pharmacoinvasive strategy of fibrinolysis followed by PCI may be a reasonable alternative.
Aim of the Study: This study is conducted to determine whether pharmacoinvasive strategy using fibrinolysis followed by routine early PCI represents a reasonable alternative to primary PCI when it is not readily available especially in patients with STEMI presenting early after symptom onset.

Patients and Methods: This is an observational prospective comparative single-center study conducted on acute STEMI patients who are presented within 12 hours from onset of symptoms at cardiovascular medicine department, Mansoura University Hospital in the period from 1st February 2017 till 28thFebruary 2019. The study includes two groups of STEMI patients; pharmaco-invasive group involving 43 patients and primary PCI group involving 51 patients with a one month follow up comparing the safety and efficacy.

Results: Pre-PCI Thrombolysis in Myocardial Infarction (TIMI) grade was better in pharmaco-invasive group (p=0.017) while there was no statistically significant difference in post PCI TIMI grade. Post-PCI myocardial perfusion grade was better in pharmaco-invasive group (P = 0.045). There was no statistically significant difference between the two groups regarding in-hospital complications(p=0136) or complications at 1 month follow up (P ˃ 0.05).
Conclusion: A pharmaco-invasive strategy is non-inferior to primary PCI in terms of reperfusion and complications.