Objective: To investigate the predictive value of serum homocysteine (Hcy) and procalcitonin (PCT) levels on the risk of myocardial hypoperfusion in patients with acute myocardial infarction (AMI) after emergency percutaneous coronary intervention (PCI). Methods: From June 2018 to April 2021, 90 patients with AMI who received emergency PCI treatment in the Department of Cardiovascular Medicine of our hospital were collected, and the relevant data were preserved completely. They were divided into a normal group (59 cases) and a hypoperfusion group (31 cases) according to the results of coronary flow classification after PCI. The clinical data, PCI treatment, and serum related indicators were compared between the 2 groups. The predictive value of serum Hcy and PCT for hypoperfusion events after PCI was analyzed by binary logistic regression model and receiver operating characteristic (ROC) curve. Results: In the hypoperfusion group, the serum Hcy and PCT levels were higher than those of the normal group, and the differences were statistically significant (P<0.05). Logistic analysis showed that after adjusting for age, serum Hcy (OR =1.506, 95%CI: 1.194 to 1.818) and PCT (OR =1.318, 95%CI: 1.095 to 1.541) were independent influencing factors of myocardial hypoperfusion events in AMI patients after PCI (P<0.05). ROC curve showed that the best cut-off values of serum Hcy and PCT levels in predicting myocardial hypoperfusion after PCI were 13.78 μmol/L and 0.12 ng/mL, AUCs were 0.864 and 0.780, sensitivities were 80.65% and 77.42%, and specificities were 74.75% and 76.44%. Conclusion: Hcy and PCT are closely related to myocardial perfusion status after emergency PCI in AMI patients at admission, which can be used as effective indexes to predict myocardial hypoperfusion events after PCI.