Early spontaneous reperfusion (SR) before recanalization therapy can reduce the infarct size and preserve left ventricular function to provide a more favorable prognosis for patients with ST-elevation myocardial infarction (STEMI); however, whether SR patients should receive primary percutaneous coronary intervention (pPCI) remains unclear. This study aimed to evaluate whether pPCI is beneficial for patients with STEMI and SR. STEMI patients with SR (n=229; defined as achievement of initial TIMI grade 3 flow in the infarction-related artery (IRA) before reperfusion therapy) who received either pPCI or non-pPCI therapy were reviewed retrospectively. The average follow-up periods were 24 +/- 4 and 23 +/- 5 months for the pPCI and non-pPCI group. Compared with the non-pPCI group, the pPCI group showed shorter hospital stay (7 +/- 3 vs. 9 +/- 5 days; P=0.02), lower in-hospital reinfarction rate (0% vs. 3%, P=0.04), lower 1-year reinfarction rate (5% vs. 10%; P=0.02), lower 1-year unscheduled PCI rate (4% vs. 12%; P=0.02), and lower 1-year composite cardiac event rate (10% vs. 29%; P<0.01). In conclusion, pPCI is beneficial for STEMI patients with angiographic SR, leading to better short-and long-term major adverse cardiac events.