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Background Adjunctive therapy with intracoronary nitroprusside (NTP) in primary percutaneous coronary intervention (PPCI) had controversial benefits in patients with ST segment elevation myocardial infarction (STEMI). Objectives To evaluate the effect of intracoronary NTP on no reflow phenomenon (NR) and clinical outcomes in STEMI patients undergoing PPCI. Methods We searched the following databases without language or time limitation in January 2014: PubMed, EMBASE, CENTRAL, ISI Web of Science, and CNKI. Trials compared the effect of intracoronary NTP with control group (placebo or no NTP treatment) on NR in STEMI patients undergoing PPCI enrolled for analyzing. Results A total of 7 trials involving 781 patients were included into this meta-analysis. Intracoronary NTP significantly reduced the incidence of thrombolysis in myocardial infarction (TIMI) flow grade (TFG) ≤2 (RR: 0.47, 95% CI: 0.30-0.73, P = 0.001); the corrected TIMI frame count (CTFC) (WMD: −5.28, 95% CI: −6.79 to 3.78, P = 0.000) increased the events of myocardial blush grade (MBG) ≥2 (RR: 1.12, 95% CI: 1.01-1.24, P = 0.038), and reduced the incidence of major adverse cardiac events (MACE) (RR: 0.43, 95% CI: 0.27-0.70, P = 0.001). Although the events of the complete ST segment resolution (STR) did not reach statistical significance, there was a trend indicating improvement in the intracoronary NTP group (RR: 1.143, 95% CI: 0.97-1.34, P = 0.101). Conclusions Intracoronary NTP can significantly reduce the incidence of angiographic NR during PPCI, as well as the incidence of MACE. It seems to be a promising adjunctive therapy for NR during PPCI. (J Interven Cardiol 2014;27:356-364) [ABSTRACT FROM AUTHOR]