No-reflow developed after coronary revascularization is an independent predictor of in-hospital mortality and poor clinical outcome. In this study, we investigated the difference between direct stenting and stenting with predilation, regarding to development of no-reflow in patients with acute coronary syndromes (ACS) and the role of fibrinolytic system in that phenomenon. Fifty eight patients with the diagnosis of ACS in whom percutaneous coronary intervention (PCI) was applied were included in study. Patients were divided into two groups according to stent application with and without predilation. Pre- and post-intervention corrected TIMI frame counts (cTFC) were calculated. Post-PCI plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA), plasminogen and D-Dimer levels were measured. Pre-intervention cTFC values were similar between stenting with and without predilation groups (P > 0.05). There was a significant decrease in post-intervention cTFC values in both groups (P < 0.002 and P < 0.05, respectively). But, there was no significant difference between post-intervention cTFC values of the groups, regardless to stent implantation techniques. (P > 0.05). In patients having high cTFC values compared with having low cTFC values; PAI-1 (P = 0.002), tPA (P = 0.015), plasminogen (P = 0.040) and D-dimer (P = 0.049) levels were significantly higher. Also, significant relationship was determined between cTFC and PAI-1, tPA, plasminogen, D-dimer levels (P values 0.003, <0.05, <0.05, and <0.002, respectively). Results of this study indicated an important role of increased fibrinolytic activity in development of no-reflow phenomenon after PCI. We didn't observe any differences between direct stenting and stenting with predilation according to the occurrence of no-reflow.