Distal embolization after percutaneous coronary intervention (PCI) is one of the major mechanisms of no-reflow. The aim of the study was to investigate clinical, angiographic predictors of distal embolization on angiography in patients with ST-elevation acute myocardial infarction (AMI) after PCI, and to assess the short-term prognosis of patients with distal embolization. There were 318 consecutive AMI patients, who underwent primary PCI within 12 h of symptom onset, and were divided into distal embolization group (N = 97) and non-distal embolization group (N = 221), based on cineangiograms performed during PCI. Distal embolization was present in 97 patients (30.5%), and more often observed in female sex (29.9 vs. 16.3%, P = 0.006), in patient with right coronary artery of infarct-related artery (IRA) (44.3 vs. 28.1%, P = 0.017), pre-revascularization thrombolysis in myocardial infarction (TIMI) flow a parts per thousand currency sign 2 (88.7 vs. 79.2%, P = 0.004), high thrombus burden (72.2 vs. 32.1%, P < 0.001). Based on logistic regression analysis, high thrombus burden on angiography (OR 5.018, 95% CI 2.843-8.857, P < 0.001) and female sex (OR 3.020, 95% CI 1.574-5.794, P = 0.001) and right coronary artery of IRA (OR 2.218, 95% CI 1.172-4.199, P = 0.014) were independent predictors of distal embolization. Patients in distal embolization group had an increased risk of short-term major adverse events (12.4 vs. 4.5%, P = 0.011) when compared with patients in non-distal embolization group. High thrombus burden on angiography before PCI and right coronary artery of IRA and female sex are the significant predictors of distal embolization in patients with AMI after PCI. In addition, distal embolization on angiography predicts an adverse short-term outcome in AMI patients.