Background: It is debatable whether immediate fibrinolysis followed by timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PPCI) early after acute ST-segment elevation myocardial infarction (STEMI). Methods: During period from December 2016 to June 2017, 60 patients with STEMI were randomly assigned to undergo either primary PCI (Group I) or immediate fibrinolysis (Group II) with subsequent coronary angiography with PCI within 3 to 24 hr later. The primary end point was a composite of all-cause death, re-infarction, and target-vessel revascularization, re-hospitalization for cardiac reasons, any stroke and major bleeding up to 30 days. Results: The primary endpoint was reported in 23% of patient who had PPCI versus 33% in those who had pharmacoinvasive strategy (RR= 0.7, 95% CI 0.31-1.58, P= 0.46). Delay time from symptom onset to each of the two reperfusion strategies was shorter in group II than group I (110 ± 27.5 versus 186.8 ± 16.6 mins respectively, P <0.001). No statistically significant differences in various components of in-hospital outcome were found between groups. Conclusion: Immediate fibrinolysis followed by coronary angiography 3-24 hr later resulted in similar short term outcome and earlier effective reperfusion in patients with STEMI compared to PPCI.