Background: When the TIMI flow is less than 3 or, in the instance of a flow of 3, when the MBG is 0 or 1, no reflow is detected (in the absence of evident vessel dissection, obstruction or distal vessel embolic cutoff). According to the TIMI flow count, the flow in the coronaries may be graded as 0 (no flow), 1 (penetration without perfusion), 2, or 3 (partial perfusion) (complete perfusion). Patients and Methods: This research included 128 individuals who had acute ST elevation myocardial infarction during the first 24 hours of experiencing symptoms and were treated at Wadi El-Nile and Ain Shams university hospitals between the years 2022 and 2023.. Results: The epinephrine group, followed by the verapamil group, followed by the adenosine group, followed by the control group, had the best TIMI flow grade and MBG scores. After taking the medicines, there was no significant difference in the TIMI thrombus grade across the 4 groups. ST segment resolution varied quantitatively across the 4 groups, but there was no statistically significant difference.. Conclusion: According to the available data, epinephrine, verapamil, and adenosine are safe and efficient in avoiding no-reflow in patients with ST Elevation Myocardial Infarction during PPCI, with epinephrine performing best, followed by verapamil, then adenosine