Aim To evaluate the safety and therapeutic effects of direct percutaneous transluminal coronary angioplasty (PTCA) in treatment of acute myocardial infarction (AMI), and compare the effects vs thrombolytic therapy. Methods 62 AMI patients without thrombolytic therapy were treated by direct PTCA after urgent coronary angiography, 59 AMI patients were treated by thrombolytic therapy. The safety and therapeutic effects of direct PTCA were studied and compared with thrombolytic therapy. Results In direct PTCA group, 60 cases were reperfused (96.7%), among which 4 were complicated with cardiogenic shock and the blood pressure raised to normal, 1 case was complicated with acute upper gastrointestinal hemorrhage, no mortality; whereas, in thrombolytic treatment group, 38 cases were reperfused (64.4%), 5 died in hospital and 2 died after discharge; 1 patient complicated with acute upper gastrointestinal hemorrhage, 1 with hematuria and 5 with cardiogenic shock; the motality was 11.9%. The rate of reperfusion in direct PTCA group was higher than that of thrombolytic therapy group; meanwhile, the incidence of major cardiac events in direct PTCA group was significantly lower than that of thrombolytic therapy (p<0.01). Conclusions Direct PTCA for treatment of AMI was safe and effective; the rate of reperfusion after direct PTCA was higher than that of thrombolytic therapy; thus, the therapeutic effects and the prognosis of direct PTCA was better than those of thrombolytic therapy.