Background: primary percutaneous coronary intervention PCI is the treatment of choice in civilized countries for acute myocardial infarction, the aim of the treatment here is the revascularization as soon as possible. Patients and methods: it is retrospective study of 133 patients of acute MI have been divided into two subgroups. The first subgroup has been treated with streptokinase infusion, and the other subgroup has beet treated by PCI. We monitored the patients within hospitalization , reinfarction, mortality, cardiogenic shock, heart failure, also we recorded the time needed to apply the method of treatment and Timi score by diagnostic cardiac catheterization after applying the treatment. Aim of study: to compare between streptokinase and PCI in our hospitals to know which way is better in which we can give the best medical care for this critical patients. Results: 63 patients undergo to pci and 70 patients undergo to streptokinase therapy. Streptokinase group had higher rates in mortality for noncardiac reasons 100%, cardiogenic shock 60% , reinfarction 81%, mortality for cardiac reasons 80%, while it was faster in applying the treatment and equal to pci in timi score. While pci group has higher rated in hospitalization for cardiac reasons 70% and in cases that has new congestive heart failure 63%, and nearly equal to streptokinase group in timi score. Conclusion: pci was better in mortality and cardiogenic shock and reinfarction than streptokinase but it was worse in hospitalization for cardiac reasons and congestive heart failure cases . pci was too late than streptokinase in applying the treatment . we notice that the two methods of treatment was nearly equal in timi score.