Objective To investigate the correlation between procalcitonin (PCT) and infarct related artery (IRA) spontaneous recanalization (SR) in patients with ST-segment elevation myocardial infarction (STEMI), and to investigate the value of PCT in predicting SR. Methods A retrospective study was conducted. A total of 263 STEMI patients who received emergency coronary angiography from January 2013 to April 2016 in cardiology department of Gansu Provincial Hospital were retrospectively included. Depending on the thrombolysis in myocardial infarction trial (TIMI) grade, the patients were divided into two groups, SR group (TIMI 2-3 grade) and non-SR group (NSR group, TIMI 0-1 grade). The baseline characteristics, serum PCT, high sensitivity C-reactive protein (hs-CRP) and biochemical makers before primary percutaneous coronary intervention (PCI) were compared. According to the value of PCT, the patients were divided into four quartile groups. SR rate of every groups were compared. Multiple logistic regression analysis was used to determine the independent predictor of SR. Receiver operating characteristic (ROC) curve was plotted to assess the diagnostic value of PCT for SR. Results In 263 STEMI patients, SR occurred in 77 patients and SR rate was 29.3%. There were no statistical differences in gender, age, body mass index (BMI), past medical history and IRA between the two groups, indicating that the baseline characteristics were matched. Compared with NSR group, utilization rate of the statins were significantly higher (35.1% vs. 22.6%, P < 0.05), the value of PCT, hs-CRP, uric acid (UA) in SR group were significantly lower [PCT (μg/L): 0.059±0.036 vs. 0.103±0.048, hs-CRP (mg/L): 3.07±4.13 vs. 5.93±7.80, UA (mmol/L): 321.4±77.4 vs. 354.2±114.1, all P < 0.05]. The quartile value of PCT were < 0.058, 0.058-0.078, 0.079-0.110, > 0.110 μg/L. SR rate were 48.5% (32/66), 29.9% (20/67), 26.9% (18/67) and 11.1% (7/63), respectively. SR rate of Quartile 1 was significantly higher than the other three groups (all P < 0.05). It was shown by multiple logistic regression analysis that PCT [odds ratio (OR) = 0.432, 95% confidence interval (95%CI) = 0.108-0.863, P = 0.016], hs-CRP (OR = 0.708, 95%CI = 0.516-0.905, P = 0.037) were independent predictors for SR. The area under the ROC curve (AUC) of PCT for predicting SR was greater than that of hs-CRP [0.784 (95%CI = 0.721-0.847) vs. 0.686 (95%CI = 0.619-0.753), P < 0.05]. When the cut-off value of PCT was 0.067 μg/L, the sensitivity was 81.6%, and the specificity was 66.7%. Conclusion PCT was independent predictor of SR, which has a power value in predicting IRA recanalization in patients with STEMI.