Aim To evaluate the efficacy and safety of the application of tirofiban in acute ST-segment elevation myocardial infarction (STEMI) patients before percutaneous coronary intervention (PCI) treatment. Methods We performed systematic searches of MEDLINE, EMBASE, and CENTRAL databases for randomized controlled trials (RCT) of tirofiban use in STEMI patients treated with aspirin and clopidogrel which reported clinical outcomes after primary PCI.Statistical analysis was conducted with RevMan 5.0. Results Four randomized controlled trials were eligible for the inclusion, involving 811 patients in tirofiban group and 813 control subjects. The application of PCI, prior to the treatment of STEMI, the routine use of tirofiban major adverse cardiovascular events (MACE) within 30 days decreased (RR＝0.63, 95%CI was 0.44～0.90, P＝0.001) all-cause mortality incidences declined (RR＝0.61, 95%CI was 0.35～1.05, P＝0.007) re-myocardial infarction incidences were not significantly different between the two groups (RR＝0.67, 95%CI was 0.34～1.31, P＝0.24) there were no significant differences in the incidences of serious bleeding (RR＝1.21, 95%CI was 0.67～2.16, P＝0.53). Conclusions Current analysis of available studies suggests that routine and early tirofiban use before primary PCI may decrease the major cardiovascular events within 30 days in STEMI patients treated with aspirin and clopidogrel without any significant increase in major bleeding.