Background: Cardiovascular disease remains the leading cause of mortality worldwide, with acute myocardial infarction (AMI) representing a significant portion of these deaths. Early intervention strategies, particularly percutaneous coronary intervention (PCI), have been shown to improve patient outcomes when administered within the therapeutic window. However, the optimal timing and approach for reperfusion therapy continue to be areas of active research and clinical debate.

Methods: This multicenter, randomized controlled trial enrolled 2,847 patients presenting with ST-elevation myocardial infarction (STEMI) across 15 cardiac centers. Patients were randomized to either primary PCI within 90 minutes of first medical contact or pharmacological thrombolysis followed by rescue PCI if indicated. Primary endpoints included 30-day mortality, major adverse cardiac events (MACE), and left ventricular ejection fraction at 6 months.

Results: Primary PCI demonstrated superior outcomes compared to thrombolysis, with 30-day mortality reduced by 23% (4.2% vs 5.5%, p=0.04). MACE occurred in 8.1% of primary PCI patients versus 12.3% of thrombolysis patients (p=0.002). Left ventricular function preservation was significantly better in the primary PCI group, with mean ejection fraction of 52.4% versus 48.7% at 6 months (p<0.001).