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Background Primary percutaneous coronary intervention (PCI) is the best treatment of choice for acute ST segment elevation myocardial infarction (STEMI).This study aimed to determine the clinical outcomes of tirofiban combined withthe low molecular weight heparin (LMWH),dalteparin,in primary PCI patients with acute STEMI.Methods From February 2006 to July 2006,a total of 120 patients with STEMI treated with primary PCI were randomised to 2 groups:unfractionated heparin (UFH) with tirofiban (group Ⅰ:60 patients,(61.2±9.5) years),and dalteparin with tirofiban (group Ⅱ:60 patients,(60.5±10.1) years).Major adverse cardiac events (MACE) during hospitalization and at 4 years after PCI were examined.Bleeding complications during hospitalization were also examined.Results There were no significant differences in sex,mean age,risk factors,past history,inflammatory marker,or echocardiography between the 2 groups.In terms of the target vessel and vascular complexity,there were no significant differences between the 2 groups.During the first 7 days,emergent revascularization occurred only in 1 patient (1.7％) in group Ⅰ.Acute myocardial infarction (AMI) occurred in 1 (1.7％) patient in group Ⅰ and in 1 (1.7％) in group Ⅱ.Three (5.0％)patients in group Ⅰ and 1 (1.7％) in group Ⅱ died.Total in-hospital MACE during the first 7 days was 4 (6.7％) in group Ⅰ and 2 (3.3％) in group Ⅱ.Bleeding complications were observed in 10 patients (16.7％) in group Ⅰ and in 4 patients (6.7％) in group Ⅱ,however,the difference was not statistically significant.No significant intracranial bleeding was observed in either group.Four years after PCI,death occurred in 5 (8.3％) patients in group Ⅰ and in 4 (6.7％) in group Ⅱ.MACE occurred in 12 (20.0％) patients in group Ⅰ and in 10 (16.7％) patients in group Ⅱ.Conclusions Dalteparin was effective and safe in primary PCI of STEMI patients and combined dalteparin with tirofiban was effective and safe without significant bleeding complications compared with UFH.Although there was no statistically significant difference,LMWH decreased the bleeding complications compared with UFH.