The major aspect of treatment of STEMI is reperfusion of the infarct related artery. Either thrombolytic therapy or primary angioplasty. Thrombolytic therapy is the older and easy to perform, where as primary angioplasty is relatively new technique and lots of skill and catheter laboratory setup is needed. We compare the short term outcome between Primary PCI (Group-I) and intravenous Streptokinase (Group-II) as reperfusion therapy for the management of acute STEMI. Pre and post procedural (1) ECG changes. (2) Improvement of TIMI flow. (3) Improvement of LV function (LVEF) and (4) Complications were compared. Study showed more improvement of ECG changes, TIMI flow and LVEF in group I patients. In complications, Primary PCI group had less MACE but no significant difference in vascular complications between two groups. This study conclude that the patient received Primary PCI has better in-hospital outcome in comparison to patient received intravenous Streptokinase for reperfusion therapy in STEMI. This book should be of interest to Interventional Cardiologists, Clinical Cardiologists,nurses of CCU & ICU and Physicians who are interested in the management of Acute Cardiac Care.