Background and Aim: A risk factor for stent thrombosis, no-reflow, and unfavorable outcomes is still intracoronary thrombus. Hematological markers' diagnostic utility in cardiovascular diseases (CVDs) is an important field for research. So our aim is to ascertain the association between various hematological markers and the high thrombus burden. Methods: This cross-sectional study included 124 cases of acute ST-elevation myocardial infarction (STEMI) and was classified into two groups; 54 cases in the group (I) had a low thrombus burden, whereas 70 cases in group (II) had a high thrombus burden. Electrocardiography (ECG), echocardiography, complete blood count (CBC) sample, lipid profile, and troponin were gathered. Results : Group II had lower high-density lipoprotein (HDL-C) with a significant difference of p<0.001. Significant higher white cell counts (WBC) count, monocytes, relative distribution width (RDW), neutrophile to lymphocytes ratio (NLR), monocytes to high-density lipoprotein ratio (MHR), and troponin were also in favor of group II. MHR at odds ratio 0.35 with 95% confidence interval (CI) and troponin at odds ratio 0.659 were significant predictors of high thrombus burden. MHR sensitivity was 78% , specificity was 65%, and p<0.001, while troponin sensitivity was 74%,specificity was 56% , and p<0.001. The cutoff values were 0.026 and 3.2 for MHR and troponin respectively. Conclusion: Troponin and MHR were simple, sensitive, and low-cost markers, might be helpful in predicting the high thrombus burden. Keywords: Predictors; Monocytes to high-density lipoprotein (MHR); High thrombus burden