Background: Patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease are common. It is unknown whether complete revascularization in these patients is superior. Objectives: This study evaluated the short term outcome of culprit only revascularization compared to total revascularization in the setting of primary percutaneous coronary intervention in patients with STEMI. Methods: The study included 40 patients with acute STEMI who were presented within 12 h from onset of symptoms. All patients had multivessel disease on emergency coronary angiography. Primary PCI was performed in all patients. According to study protocol, patients were divided into 2 groups: group A (20 patients) included patients who underwent culprit artery only revascularization, while group B (20 patients) had total revascularization. In-hospital and 30 days outcome (mortality, re-infarction, heart failure, recurrence of angina symptoms, cerebrovascular stroke, need for revascularization) were reported. Results: All cause mortality was reported in one patient from group B (5%). No re-infarction. Recurrence of ischemic symptoms was reported in 15% of patients (25% versus 5% in groups A and B respectively, P=0.2). Heart failure was evident in 15% of all patients (15% in each group). Composite end point of adverse cardiovascular events was reported in 37.5% of all patients (40% versus 35% in groups A and B respectively, P = 0.5). Contrast induced nephropathy was evident in 47.5% of patients (10% versus 35% in groups A and B respectively, P = 0.08), subacute stent thrombosis occurred in 2 patients (5%), (10% in group B but not in group A, P = 0.4). Conclusion: Both treatment strategies carry equivalent short term outcome among patients with STEMI treated with PPCI.