In the last two decades, primary percutaneous coronary intervention (PPCI) became the initial choice of management of patients who present as acute ST-segment elevation myocardial infarction (STEMI). It is majorly used to achieve restoration of epicardial flow at earliest, to reduce the severity of myocardial injury. In spite of various advancements in percutaneous coronary intervention (PCI), subsequent no-reflow phenomenon and distal embolization are certain complications. Direct stenting (DS) without balloon pre-treatment is preferred therapeutic strategy which is associated with various advantages over conventional stenting (CS) like reduced no-reflow episodes, better angiographic outcomes, shorter time of procedure and fluoroscopy times and lower procedural cost. However, long-term clinical outcomes of DS as compared to CS needs to be explored. This review article highlights various meta-analysis and prospective randomized studies between DS and CS in patients undergoing PCI presenting with STEMI. The authors are also describing retrospective observational study of DS in STEMI which was observed.