Primary angioplasty for acute myocardial infarction (PAMI) proved superior to thrombolysis in many major trials. However, PAMI is available in only limited number of centers particularly in developing countries. On the other hand, it was clearly shown that thrombolysis when given early is associated with a comparable outcome to PAMI. It is however not known if this can apply to streptokinase (SK) that is the most widely used lytic agent in developing countries. The aim of this study was to assess the in-hospital outcome of patients given early thrombolysis using SK. From the Monastir AMI registry including 1148 patients, 403 received SK therapy. This population was divided into three groups based on the delay between the onset of symptoms and treatment: Group I: 0 – 3 hours (n= 208), Group II: 3 – 6 hours (n= 145) and Group III more than 6 hours (n = 50). Mean age was 60.3 +/− 12 years, 349 (86.6%) were male. Baseline characteristics were similar between the three groups. Clinical reperfusion defined as sedation of chest pain and ST elevation regression for more than 50% from baseline was observed in 75.1% of Group I, 58.8% of Group 2 and in 46.8% of Group 3 pts. (p < 0.01). In hospital mortality and complications are compared between the three groups in the table below. Early thrombolysis (less than 3 hours from chest pain onset) using streptokinase is associated with a very high percentage of clinical reperfusion (75%), a lower rate of heart failure and mortality. These results have important clinical implications particularly in developing countries. Group I Group II Group III p Heart failure 31 (14.9%) 37 (25.5%) 18 (36%) 0.001 Ventricular fibrillation 8 (3.8%) 10 (6.9%) 2 (4%) 0.407 Ventricular tachycardia 6 (2.9%) 10 (6.9%) 4 (8%) 0.133 Pericarditis 10 (4.8%) 7 (4.8%) 4 (8%) 0.636 Death 14 (6.7%) 9 (6.2%) 7 (14%) 0.166