Objective To observe the effect of reverse thrombolysis combined with PCI on acute ST-segment elevation myocardial infarction. Methods 48 patients with acute ST-segment elevation myocardial infarction were randomly divided into two groups: reverse thrombolysis combined with PCI group and direct PCI group, including 24 patients respectively. Reverse thrombolysis combined with PCI means that pro-urokinase is injected into the occlusion segment for reverse thrombolysis, then PCI is performed. The incidences of slow-flow and no-reflow, the incidence of reperfusion arrhythmia, the incidence of bleeding in the two methods were compared. Results In the reverse thrombolysis combined with PCI group, slow-reflow in 1 case, transient bradycardia after PCI in 1 case, while in PCI group, slow-reflow in 3 cases, no-reflow in 2 cases, transient ventricular tachycardia after PCI in 6 cases, electrical conversion given to 2 cases, transient bradycardia in 2 cases, no cerebral hemorrhage and gastrointestinal bleeding occurring in both groups, and symptoms of repeated heart failure occurring in 2 cases. After comparison of both groups, the incidence of postoperative slow-reflow and no-reflow (P=0.013), and the incidence of reperfusion arrhythmia (P=0.001) were statistically significant, and the incidence of bleeding (P=1.000) was of no statistical significance. Conclusions With regard to the acute ST-segment elevation myocardial infarction, reverse thrombolysis combined with PCI can significantly reduce the occurrence of slow-reflow and no-reflow and reperfusion arrhythmia, and thus improve the long-term prognosis of patients, without increasing the incidence of bleeding and other complications.