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Background The no-reflow phenomenon is correlated with adverse effects on short-term and long-term out-comes of ST-elevation myocardial infarction (STEMI) in patients undergoing primary percutaneous coronary intervention (PCI).The lymphocyte-to-monocyte ratio (LMR) is a novel inflammatory marker which is associated with slow coronary flow.We aimed to investigate the predictive value of LMR for no-reflow phenomenon in patients with STEMI undergoing primary PCI.Methods A total of 1350 STEMI patients were enrolled in this study from January 2014 to January 2018.Blood samples were obtained at initial admission for analysis of LMR.The univariate and multivariate logistic regression analysis was performed to study the relationship between LMR and no-reflow phenomenon.Results All the 156 patients among the study population suffered from no-reflow phenomenon during the procedure.The LMR level was significantly lower in patients with no-reflow (1.6 ± 1.0 vs.3.25 ± 1.8,P<0.001).Multivariate logistic regression analysis showed that LMR was independently associated with no-reflow post primary PCI in STEMI patients.(OR 2.356,95% CI 1.201-5.945;P=0.030).The area under the ROC curve for the LMR was 0.757 [95% confidence interval (CI) 0.686-0.828,P<0.001].Contusions LMR at admission could serve as a biomarker for no-reflow phenomenon in patients undertaken primary PCI for STEMI.