Background: Primary angioplasty (PCI) for acute myocardial infarction is associated with no-reflow phenomenon, in about 5–25% of cases. Here we analysed the factors predicting no reflow . Methods: This was a case control study of consecutive patients with acute myocardial infarction who underwent Primary PCI from August 2014 to February 2015. Results: Of 181 patients who underwent primary PCI, 47 (25.9%) showed an angiographic no-reflow phenomenon. The mean age was 59.19 ± 10.25 years and females were 11%. Univariate predictors of no reflow were age >60 years (OR = 6.146, 95%CI 2.937–12.86, P = 0<0.001), reperfusion time >6 h (OR = 21.94, 95%CI 9.402–51.2, P = < 0.001), low initial TIMI flow (≤1) (OR = 12.12, 95%CI 4.117–35.65, P < 0.001), low initial TMPG flow (≤1) (OR = 36.19, 95%CI 4.847–270.2, P < 0.001) a high thrombus burden (OR = 11.04,95%CI 5.124–23.8, P < 0.001), a long target lesion (OR = 8.54, 95%CI 3.794–19.23, P < 0.001), Killip Class III/IV(OR = 2.937,95%CI 1.112–7.756,P = 0.025) and overlap stenting(OR = 3.733,95%CI 1.186–11.75,P = 0.017). Multiple stepwise logistic regression analysis predictors were: longer reperfusion time > 6 h (OR = 13.844, 95%CI 3.214–59.636, P = <0.001), age >60 years (OR = 8.886, 95%CI 2.145–36.80, P = 0.003), a long target lesion (OR = 8.637, 95%CI 1.975–37.768, P = 0.004), low initial TIMI flow (≤1) (OR = 20.861, 95%CI 1.739–250.290, P = 0.017). Conclusions: It is important to minimize trauma to the vessel, avoid repetitive balloon dilatations use direct stenting and use the shortest stent if possible.