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Background: The factors associated with incomplete ST-segment resolution (STR) after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) were still not clear. Aim:The main aim of the current study was to identify the factors associated with incomplete STR after PPCI in a group of patients with acute STEMI in Erbil city, Iraq. Patients and Methods: In this cross-sectional study, STR was performed 30 minutes after PPCI in 120 patients with acute STEMI. Patients were divided into two groups according to the degree of STR; group I, 86 patients with complete STR (≥ 50%), and group II, 34 patients with incomplete STR (< 50%). Both groups were evaluated and compared regarding baseline clinical and angiographiccharacteristics by univariate and multivariate analysis. Results: Group II patients were more diabetic and hypercholesterolemic, witha high incidence of prior myocardial infarction. Besides, they had a high prevalence of Killip II and III classes, more anterior and lateral wall infarctions, higher heart rate, with high blood urea,creatinine, troponin,and CK-MB levels. Moreover, they had a lower left ventricular ejection fraction (LVEF). In addition, they had a higher incidence of the occluded left main and left anterior descending arteries,more number of occluded coronary arteries, a higher rate of pre-intervention TIMI flow grade 0,and a lesser rate of post-interventional TIMI flow grade 3. Conclusion:Several factors were associatedwith incomplete STR .TIMI flow grade, number of diseased arteries, blood urea, and serum creatinine were associated with the highest probability of incomplete STR. Diabetes mellitus, previous MI, Killip class, heart rate, LVEF, culprit coronary artery, troponinand CK-MB levels were also significantly associated with incomplete STR.