Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO) or no-reflow phenomenon represent components of reperfusion injury. There’s not enough data on quota of these phenomena in patients with primary STEMI. Purpose — the purpose of the study was to evaluate the prevalence of IMH and MVO in patients with primary STEMI by CMR. Materials and methods. The study included 47 patients with primary STEMI in the first 12 hours after the onset of disease. Exclusion criteria: pulmonary edema, cardiogenic shock, creatinine clearance <30 mL/min or dialysis, severe comorbidity, acute psychotic disorders and unability to undergo or contra-indications for cardiac magnetic resonance (CMR). CMR imaging was performed at 2 day post-STEMI in everybody. MVO was imaged using late gadolinium enhancement and T2-weighted CMR imaging for microvascular obstruction and IMH. Results. IMH and MVO were revealed in majority of the patients with primary STEMI (70.2%). The combination IMH with MVO were occurred in 14 patients (29.8%): in group of pharmaco-invasive strategy — 6 patients (20%) and in group of primary PCI — 8 patients (47%). The combination of IMH with MVO was presented also significantly more frequently in group of primary PCI (p=0.03). Conclusion. IMH and MVO were common findings in patients with primary STEMI different reperfusion strategies. combination of IMH with MVO were occurred more frequently among patients treated with primary PCI.