Primary PCI involves performing urgent angioplasty and potentially stenting of the culprit artery in STEMI patients, with the goal of reopening the blocked vessel within 90 minutes of first medical contact. It is the preferred reperfusion strategy when it can be performed promptly by an experienced team. Factors such as patient age, time to treatment, comorbidities, and initial flow in the artery help determine whether primary PCI or thrombolysis is most appropriate. Optimal anticoagulation and antiplatelet regimens along with adjunctive therapies like manual thrombectomy can improve outcomes of primary PCI.