Background: One of the main causes of death in the developed world is acute myocardial infarction. Non-ST-segment elevation myocardial infarction (NSTEMI) and ST-segment elevation myocardial infarction (STEMI) are two types of acute myocardial infarction (AMI). Objective: To assess the value of using highly sensitive troponin and the neutrophil-lymphocyte ratio (NLR as marker to predict the complexity of angiographic coronary anatomy in AMI patients assessed by SYNTAX score. Patients and Methods: In this study, 100 cases with AMI who had coronary angiography with or without stent implantation between November 2021 and May 2022 were included. These patients came to the Emergency Departments of Ain Shams University Hospitals and Misr University for Science and Technology (MUST) Hospitals. A serum sample was acquired for differential CBC counts in order to assess neutrophil-to-lymphocyte ratio (NLR) and zero-point high sensitive troponin to be correlated by SYNTAX score. Results: The study reported that there was a marked correlation between the NLR and the coronary lesions complexity evaluated by SYNTAX score, but the study couldn't found any correlation between the high sensitive troponin level and coronary lesions complexity. Conclusion: An increased in NLR on admission is a potential and independent predictor of the complexity of the coronary lesions, but there is no significant correlation between high sensitive troponin level and the complexity of coronary lesion.