【Abstract】 Objective To study the effect of treatment with reteplase and alteplase on plasma homocysteine (Hcy), brain natriuretic peptide (BNP) and cardiac troponin T (cTnT) levels in patients with STsegment elevation myocardial infarction (STEMI). Methods 80 patients with STENMI admitted to the hospital from December 2015 to December 2017 were selected as the subjects. According to the order of treatment, they were divided into reteplase and alteplase group, 40 cases in each group. Reteplase group was given reteplase thrombolytic therapy while alteplase group was given alteplase thrombolytic therapy. The recanalization rate within 120 min after thrombolytic therapy was compared between the two groups. Plasma Hcy, BNP and cTnT levels were detected. The incidence rates of cardiovascular events within 30d after thrombolytic therapy and bleeding complications during hospitalization were statistically analyzed. Results The recanalization rates in reteplase group at 60min and 120min recanalizationafter thrombolytic therapy (650%, 875%) were significantly higher than those in alteplase group (425%, 625%) (P＜005). Levels of Hcy, BNP and cTnT in reteplase group at 48h after thrombolytic therapy ［(1523±274) μmol/L, (70345±12662) ng/L, (885±155) μg/L］were significantly lower than those in alteplase group ［(1707±308) μmol/L, (77334±13740) ng/L, (964±176) μg/L］(P＜005). There was no significant difference in the total incidence of cardiovascular events or bleeding complications between the two groups (P＞005). Conclusion Compared with alteplase, the recanalization rate of reteplase is high. The latter can effectively reduce plasma BNP, Hcy and cTnT levels in patients with STEMI and reduce myocardial injury.