Abstract: AIM To evaluate the effect of intracoronary tirofiban and manual thrombus aspiration on patients with ST-elevation myocardial infarction (STEMI). METHODS The study enrolled 240 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI). The patients were divided into four groups: primary PCI group, intracoronary tirofiban group, thrombus aspiration group and combined treatment group of intracoronary tirofiban and thrombus aspiration. Myocardial reperfusion and 6-month major adverse cardiac events were assessed. RESULTS Compared with primary PCI group, myocardial blush grades (MBG) 2-3 were more frequent in treatment groups and much higher in combined treatment group. TIMI flow grade 3 and complete ST-segment resolution were significantly increased in thrombus aspiration group and combined treatment group and were much higher in combined treatment group than those in thrombus aspiration group, although the p value was not significant. Major adverse cardiac events were reduced in the thrombus aspiration group at 6-month follow up. CONCLUSION Myocardial reperfusion and clinical outcomes are improved in thrombus aspiration group. However, combined treatment of intracoronary tirofiban and thrombus aspiration does not improve myocardial reperfusion and clinical outcomes.