Background: The no-reflow phenomenon is critical and, if not reversed, causes a high rate of morbidity and mortality. It was demonstrated that the no-reflow phenomenon after Primary percutaneous coronary intervention (pPCI) is a strong predictor of mortality after the acute event in patients with STEMI. The aim of this study was to investigate the impact of visible thrombus aspiration (VTA) material on no reflow and its relation to hospital mortality and early outcomes in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (pPCI). Methods: This prospective observational study conducted on 100 patients admitted with acute STEMI and treated with primary PCI within 24 hours of presentation. Patients were divided into two groups: Group VTA (n=58):  who had visible thrombus aspiration material (VTA) (defined as collected visible aspiration material, including atherothrombotic debris or thrombus) & Group non VTA (n=42):  who had non-VTA (defined as no visible aspiration material and only blood). Results: There was significant statistical difference between group VTA & Group non VTA as regard No reflow after aspiration(15.5%vs 45.5%, P =0.001), In hospital mortality (0% vs 9.5% ,P = 0.016), LVEF at hospital (47.90 ± 5.38 vs 42.36 ± 5.95, P =0.001) and LVEF after 1 month (51.90 ± 4.36 vs 48.83 ± 4.53, P =0.001). However, there was no significant statistical difference between both groups as regard baseline TIMI flow, syntax score, in-hospital MACE, length of hospital stays. Conclusions: Our study resulted in aspiration of macro visible thrombus materials led to lower rates of no reflow after aspiration and better short-term clinical outcomes and prognosis than those patients with non-visible thrombus aspiration materials with ST-elevation myocardial infarction treated with pPCI.