Aim To observe the curative effect of reteplase(rPA)and recombinant streptokinase(r-SK)in the patients with ST-elevation myocardial infarction(STEMI). Methods Forty patients with STEMI had accepted rPA(22 cases)or r-SK(18 cases),The patency of infarct-related coronary artery was assessed by unified clinical criteria.The revascularization rate,mortality,cardia failure,shock and incidence of bleeding complications were observed. Results 120 minutes after thrombolysis,the revascularization rate were 86.36%,66.66% in rPA group and r-SK group respectively.The early reperfusion rates(60 minutes and 90 minutes)of rPA group is higher than those of r-SK group.The differences was statically significant(P<0.05).The rates of recurrent myocardial infarctions,heart failure,cardiac shock,postinfarction angina pectoris showed no differences in two groups 30 days after thrombolysis(P>0.05).The mortalities of two groups were 4.55% in rPA group,5.55% in r-SK group(P<0.05).Bleeding incidence was more often in rPA group than in r-SK group(P<0.05). Conclusion Reteplase and recombinant streptokinase are all effective and safe thrombolytic agents in the treatment of STEMI in emergency department.The early reperfusion rate of reteplase is higher than that of recombinant streptokinase.