Background: in patients with acute myocardial infarction, the immediate therapeutic goal is to establish patency of the infarct-related artery and to achieve optimal myocardial tissue reperfusion. The Synergy between percutaneous coronary intervention with TAXUS and cardiac surgery (SYNTAX) score (SS) quantifies the extent and complexity of angiographic coronary artery disease. Patients and Methods: a total of 543 patients presenting with acute myocardial infarction undergoing primary PCI for the STEMI patients and early invasive strategy for the NSTEMI patients, both admitted within 24 hours from the symptoms onset, were analyzed. SS, thrombolysis in myocardial infarction (TIMI) flow grade score, and TIMI myocardial blush grade score (MBG) were determined in all patients. No-reflow was considered as the prescence of TIMI blood flow in the infarct related artery (IRA)  2 or TIMI grade 3 with myocardial blush grade (MBG) 0 or 1, at least 10 minutes after the end of the PCI procedure. Results: no-reflow was observed in 26% of patients. The mean SS of the no-reflow group was higher than that of the TIMI III flow group . On multivariate logistic regression analysis a long target lesion (OR= 8.637, 95% C.I 1.975–37.768, p = 0.004) were found to be significantly associated with no-reflow and were the independent predictors of no-reflow phenomenon. The cutoff value of SS obtained by the receiver-operator characteristic curve analysis was 31 for the prediction of no-reflow . Conclusion: the SS is a predictor of no-reflow in patients with acute myocardial infarction treated with percutaneous coronary intervention.