Despite the recent improvements in percutaneous coronary intervention (PCI), angiographically visible distal embolization (AVDE) complicates 6 to 18% of ST elevation myocardial infarction (STEMI) treated with PCI, and is associated with poor clinical outcomes. Culprit lesion characteristics have been proved to be the main predictive factor of AVDE. But data regarding clinical characteristics predicting AVDE are lacking. We aimed to identify predictors of AVDE complicating PCI in STEMI management. 769 consecutive patients admitted for STEMI who underwent PCI were included. Clinical, angiographic and therapeutics characteristics were assessed for each patien. AVDE was defined as an abrupt vessel closure occurring at any point during the PCI procedure and that was not present at baseline. Thrombectomy was used only when thrombolysis in myocardial infarction flow was≤2. AVDE occurred in 112 (14.5%) patients. Patients with AVDE were older (67±14 vs. 63±14; with p=0.010), less likely to be men (59 vs. 74%; with p=0.002), have more frequently an artery diameter>3mm (36 vs. 28%: with p=0.046), a right coronary artery culprit lesion site (59 vs. 37%; with p<0.001) and more frequent thrombectomy (53 vs. 43%, with p=0.045). There was no difference regarding the other cardiovascular risk factors neither regarding syntax score. By multivariate analysis, age>60 (OR[95% CI]: 1.69 (1.09-2.64); p=0.020), female gender (OR[95% CI]:1.71(1.09-2.70); p=0.020), thrombectomy (OR[95% CI]:1.67(1.10-2.53); p=0.016) and the right coronary artery culprit lesion site (OR[95% CI]:2.52(2.1.66-3.81); p<0.001) were independent factors associated with AVDE. AVDE complicating PCI in STEMI management is frequent (14.5%). Strikingly we found no association between AVDE and culprit lesion characteristics. Conversely, clinical characteristics as age (>60 year-old), female gender, thrombectomy and the right coronary artery culprit lesion site are the most powerful predictive factors of AVDE.