Background: Clinical characteristics are combined with an angiographic grading method to create the SYNTAX Score II, which then compares the results to the SYNTAX II score. Objective: This study aimed to make an early prediction of no reflow in patients receiving primary percutaneous coronary intervention (PPCI) because of an acute ST-segment elevation myocardial infarction (STEMI), the SYNTAX score II was used. Patients and Methods: Our cross-sectional trial was conducted on one hundred patients with acute STEMI who underwent primary percutaneous coronary intervention at National Heart Institute, Zagazig University Hospital. Standard coronary angiogram was done to all patients. Results: A statistically significant positive correlation was found between syntax score and age, also with LVESD post treatment, while there was significant negative correlation with both EF pre- and post-treatment and TIMI flow grade. According to the results of the multivariate logistic regression analysis, the most significant risk variables for no reflow were revealed to be the door to balloon time > 2 hours, smoking, syntactic score > 27, EF below 44, and finally, chronic kidney disease. Conclusion: An independent predictor of no-reflow in STEMI patients who are treated with PPCI is the syntax score.