BACKGROUND: This study was sought to evaluate the relationship between admission neutrophil lymphocyte ratio (NLR) and estimated coronary flow by the TIMI frame count (TFC) method in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). METHODS: TFC of 262 consecutive STEMI patients were evaluated after PPCI. Admission NLR were calculated and TFC was determined after PPCI. According to admission NLR value, patients were divided in to two groups. NLR levels higher than 3.5 were defined "higher NLR" whereas lower than 3.5 were accepted as "lower NLR". RESULTS: TFC was significantly higher in patients with higher NLR (56.6±41.1 vs. 37.9±36.1, P<0.001). No-reflow phenomenon was more frequent in higher NLR group compared to lower NLR group (10.1% vs. 5.2%, P=0.001). In multivariate linear regression analysis admission NLR was an independent predictor of high TIMI frame count (B=2.24 95 % CI (1.17-3.31), P<0.001). CONCLUSIONS: Our findings suggest that admission NLR predicts coronary blood flow in means of TFC.