Objective：To investigate the relationship between CHA2DS2-VASc score combined with neutrophil to lymphocyte ratio （NLR） and no-reflow phenomenon after direct percutaneous coronary intervention （PCI） in patients with acute ST-segment elevation myocardial infarction （STEMI）. Methods：A total of 275 patients with acute STEMI who received direct PCI in the Department of Cardiology，Hebei General Hospital from September 1，2018 to December 31，2019 were selected as the study subjects. All clinical data and examination indicators of patients were collected. According to the results of angiography，they were divided into two groups：the reflow group （n=228） and no-reflow group （n=47）.The independent influencing factors of no-reflow after PCI in STEMI patients were analyzed，and receiver operating characteristic （ROC） curve was drawn to analyze the predictive value of CHA2DS2-VASc score，NLR and their combined factors for no-reflow after PCI in acute STEMI patients. Results：CHA2DS2-VASc score，NLR and intraoperative predilation in patients no-reflow were higher than those in reflow group （P<0.05）. Binary Logistic regression analysis showed that CHA2DS2-VASc score and NLR were independent influencing factors of no-reflow after PCI in acute STEMI patients （P<0.05）. ROC curve results showed that：CHA2DS2-VASc score （AUC：0.640，95%CI0.562~0.719，P=0.002），NLR （AUC：0.631，95%CI0.541~0.721，P=0.005） had certain predictive power for no-reflow phenomenon，but the combined predictive factor（AUC：0.675，95%CI0.589~0.762，P<0.001）were higher in AUC，which could better predict the occurrence of no-reflow after direct PCI in STEMI patients. The predictive power of combined predictors was compared with CHA2DS2-VASc score alone and NLR alone. There were no statistical differences（P>0.05）. Conclusion：CHA2DS2-VASc score and NLR are independent predictors of no-reflow.The combination of the two has a good predictive value for the occurrence of no-reflow after PCI in acute STEMI patients，but does not show a better predictive value than CHA2DS2-VASc score or NLR alone.