Aim To evaluate the efficacy and safety of prourokinase administration in coronary artery of patients with acute myocardial infarction before PCI. Methods Pubmed, Wanfang Data, CBM, CNKI and VIP databases were searched for randomized controlled trial (RCT) of prourokinase administration in coronary artery of patients with acute myocardial infarction before PCI. The retrieval time limit was from the establishment of database to 2020. The quality of literature was evaluated by the improved Jadad scoring method. RevMan 5.2.0 was used for statistical analysis. Results A total of 10 RCT were included, 1 252 patients with acute myocardial infarction, including 628 patients in the control group (routine treatment before PCI) and 624 patients in the experimental group (prourokinase plus the control group). The results of Meta analysis showed that TIMI blood flow grade was greater in the experimental group than that in the control group(RR=1.26,95%CI(1.16,1.36),P＜0.000 01), and the incidence rate of corrected TIMI frame count (cTFC) was greater in the experimental group than that in the control group(MD=－7.23,95%CI(－10.19,－4.27), P＜0.000 01); left ventricular ejection fraction (LVEF) was higher in the experimental group than that in the control group during hospitalization and 1 week after PCI(MD=3.47,95%CI(2.01,4.93),P＜0.000 01); LVEF was higher in the experimental group than that in the control group within one month after PCI (MD=2.92,95%CI(0.33,5.50),P=0.03); LVEF was higher in the experimental group than that in the control group within six months after PCI (MD=3.0,5%CI (2.4,5.07), P＜0.000 01); The incidence rate of major adverse cardiovascular events (MACE) was lower in the experimental group than in the control group within 1 month after PCI(RR=0.32,95%CI(0.22,0.48),P＜0.000 01); the incidence rate of MACE was lower in the experimental group than that in the control group within 1 year after PCI (RR=0.32,95%CI(0.19,0.53),P＜0.000 1). There was no significant difference between the experimental group and the control group in the incidence rate of bleeding events within one month after PCI(RR=0.93,95%CI(0.62,1.40) ,P=0.73); there was no significant difference between the experimental group and the control group in the incidence rate of bleeding events more than half a year after PCI(RR=1.49,95%CI(0.44,5.12),P=0.52). Conclusion The application of prourokinase thrombolysis in the coronary artery before PCI can further improve the myocardial perfusion level of patients with acute myocardial infarction, improve the left ventricular function of patients after PCI, reduce the incidence of MACE, and do not increase the incidence of bleeding events, which has a better clinical effect.