Objectives: The neutrophil to lymphocyte ratio (NLR) has been investigated as a new predictor for cardiovascular risk. Admission NLR would be predictive of adverse outcomes after primary angioplasty for ST-segment elevation myocardial infarction (STEMI). Methods: A total of 2410 patients with STEMI undergoing primary angioplasty were retrospectively enrolled. The study population was divided into tertiles based on the NLR values. A high NLR (n = 803) was defined as a value in the third tertile (> 6.97), and a low NLR (n = 1607) was defined as a value in the lower 2 tertiles (<= 6.97). Results: High NLR group had higher incidence of inhospital and long-term cardiovascular mortality (5% vs 1.4%, P < .001; 7% vs 4.8%, P = .02, respectively). High NLR (> 6.97) was found as an independent predictor of inhospital cardiovascular mortality (odds ratio: 2.8, 95% confidence interval: 1.37-5.74, P = .005). Conclusions: High NLR level is associated with increased inhospital and long-term cardiovascular mortality in patients with STEMI undergoing primary angioplasty.