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Objective: To determine the association between minimal and maximal manipulation and slow/no flow during Primary Percutaneous Coronary Intervention (PPCI) and its associated outcomes. Study Design: Analytical, Cross-Sectional study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases, from Mar to May 2023 Methodology: Total 189 patients were enrolled through non-probability consecutive sampling in the present study. STElevation Myocardial Infarction (STEMI) patients irrespective of age and gender were included. Patients were grouped into minimal and maximal manipulation groups and subsequently PPCI was proceeded. During procedure, TIMI-flow grading was assessed and patients were further grouped into no flow (TIMI-0 or 1), slow flow (TIMI-2) and normal flow (TIMI-3) group. Outcome variables including TIMI-flow, arrhythmia, Heart Failure (HF) and in-hospital mortality were observed. Chi-square test and student t-test were applied and p-value <0.05 was taken as significant. Results: The mean age of the study sample (n=189) was 60.2±11.6 years. 153(80.9%) participants were males and 36(19.0%) were females. 132(69.8%) patients had normal flow,34(17.9%) had slow flow and 23(12.2%) had no flow. 95(50.3%) patients had minimal manipulations and 94(49.7%) had maximal manipulation. There was insignificant association of type of manipulation with HF, type of arrhythmias and type of blood flow (p>0.05). Frequency of mortality was higher in maximal manipulation group 7(7.4%). In relation to reflow; diabetes, multiple pre-stenting balloon inflation and multiple post-stenting balloon inflation, and type of arrhythmia were significantly ................... Conclusion: There was no role of minimal and maximal manipulation in developing slow flow/no flow during primary PCI.