BACKGROUND AND OBJECTIVES: Previous data showed similar clinical outcome of reperfusion therapy by primary percutaneous coronary intervention (PPCI) versus thrombolysis in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) within 3 hours of the onset of symptoms. But in drug eluting stent(DES) era and current real world practice, we have little data. The aim of the present study was to compare the clinical outcomes of patients with STEMI within 3hours of onset of symptoms according to reperfusion methods. SUBJECTS AND METHODS: Between 2008 and Aug 2011, 2510 patients (2006 male, 498 female; age=68.5 years) were enrolled a nationwide prospective registry of Korea Working Group on Myocardial Infarction (KorMI). Clinical outcome was analyzed according to reperfusion therapy in the field of acute STEMI within 3hours of onset of symptoms. RESULTS: The primary end points were cardiac death and major adverse cardiac events (MACE). A total of 2510 patients (thrombolysis 186, PPCI 2324) were enrolled. Mean follow up period was 732 day. There were no significant differences in baseline characteritics except Killip class, body weight, Regional wall motion abnormality (RWMA) score. More patients with reperfusion therapy by PPCI had Killip 3 and 4 class than thrombolysis and the patients with revascularization by PPI was lower weight and had higher RWMA score. In on third patients(66, 34%) of thrombolysis group, adjunctive or rescue PCI were performed after thrombolysis. There were no significant differences in the incidence of death and MACE during clinical follow-up between two groups ( p < 0.456). When we excluded the patients with Killip 4 class, there were also no significant differences in the incidence of end points. CONCLUSIONS: In current real world practice and DES era, PPCI and thrombolysis were similar efficacy of reperfusion therapy for the patients with STEMI 3hours of onset of symptoms as well. But in the one third of patient with revascularization by thrombolysis, adjunctive or rescue PCI were performed after thrombolysis therapy.