Abstract： Objectives To compare primary stenting in the infarct-related coronary artery with intrave nous rt-PA therapy plus rescue intracoronary stenting.Methods Ninety-eight patients with a first acute myocardial infarction (AMI) were rando mly treated with primary intracoronary stenting (primary stenting group) or with intravenous rt-PA therapy plus rescue intracoronary stneting (thrombolysis plu s stenting group).Thrombolysis in myocardial infarction (TIMI) flow grade was assessed by angiography in emergency, and cardiac function (left ventricular eje ction fraction, LVEF) was calculated by echocardiography before discharge betwee n the two groups.Results There were 47 patients (97.91%) in primary stenting group and 50 patients (100% ) in thrombolysis plus stenting group had achieved TIMI grade 2-3 flow after th e procedure. But the former had more cases (93.8%) of TIMI 3 flow than that o f latter (60.0%, P=0.0001). There was no difference between the two group s in cardiac events during hospitalizaton. But the patients in primary stenting group had better cardiac function (LVEF 0.62±0.14 vs 0.50±0.12, respectiv ely, P=0.0001) between the two groups.Conclusions Primary intracoronary stenting may improve myocardial reperfusion in emergency a nd inhibit the decline of cardiac function after AMI in comparison with intraven ous rt-PA thrombolysis plus rescue intracoronary stenting.