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Background Ischemic heart disease represents nearly 1.8 million annual deaths or 20% of all Europe deaths. Reperfusion of the ischemic myocardium decreases infarct's size and improves left ventricular function and clinical outcome in patients with acute myocardial infarction. Objective The study evaluated the outcome of revascularization strategies [primary percutaneous coronary intervention (PPCI) and fibrinolytic] for patients who presented with ST-segment elevation myocardial infarction (STEMI). Patients and methods This is an observational retrospective study that was conducted during March 1, 2018 and August 31, 2018. The study included 232 patients divided into group A (186 patients of them underwent PPCI) and group B (66 patients who received streptokinase). Results In group A, 76.9% of them were males, 33.9% were diabetic, 30.1% were hypertensive, 55.4% were smokers, and 17.7% were addicts, whereas in group B, 77.3% were males, 59.1% were smokers, and 16% were addict, and it was found that diabetes mellitus and hypertension presented in 54.5% and 50 of patients, respectively. Anterior myocardial infarction and KILLIP I presentation were nearly the same in both groups. In-hospital mortality was statistically higher in group B than group A (18.18 vs 8.6%; P = 0.03). Moreover, the mean of ejection fraction by Simpsons during admission at the PPCI patient was found higher in group A than that in the group B (51.20 ± 9.19 vs 46.7 ± 7.61; P = 0.001). Conclusion The implementation of PPCI service is beneficial in patients with STEMI in the form of lower in-hospital mortality and better ejection fraction, so primary PCI is preferred as a strategy in patients with STEMI.