The aim of this study was to evaluate the effect of thrombolytic therapy on neurologic outcome and mortality in patients after cardiac arrest due to acute ST-elevation myocardial infarction and to compare this with those in patients treated with primary percutaneous coronary intervention (PCI). We retrospectively examined patients after they had ventricular fibrillation cardiac arrests. To assess the effect of thrombolysis and PCI on outcome, we used odds ratios and their 95% confidence intervals and logistic regression modeling. Thrombolysis was applied in 101 patients (69%) and PCI in 46 patients (31%). More patients who received thrombolysis had favorable functional neurologic recovery (cerebral performance category 1 and 2) and survived to 6 months compared with patients with primary PCI (P = .38 and P = .13, respectively). In patients with cardiac arrest due to ST-elevation myocardial infarction, it may be acceptable to use thrombolysis as a reperfusion strategy. This applies especially in hospitals where immediate PCI is not available.