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OBJECTIVE To determine the association between hypertensive retinopathy (HR) and post ST elevation myocardial infarction (STEMI) complications among successfully thrombolysed patients. STUDY DESIGN A cohort study. PLACE AND DURATION OF STUDY Cardiology Unit, Lady Reading Hospital, Peshawar, from June 2016 to December 2017. METHODOLOGY Patients with history of hypertension for at least 5 years who presented with STEMI and were successfully thrombolysed, were included. On the basis of fundoscopy, patients were grouped into no, mild, moderate, and severe hypertensive retinopathy. Primary and secondary endpoints included a composite of death, re-MI, stroke, re-hospitalisation secondary to left ventricular failure, cardiogenic shock, arrhythmia, heart block, and ventricular septal rupture at 30 days and 4 months, respectively. Association between hypertensive retinopathy and post STEMI complications was determined by Chi-square test. Regression model was used to calculate relative risk of complications with hypertensive retinopathy. P <0.05 was taken as significant. RESULTS A total of 118 patients with a mean age of 54.83 ±8.6 years were included in the study. Of these, 49.2% (n=58) were males. Moreover, 38.1% (n=45) of patients were grouped under no HR, 22.8% (n=27) under mild HR, 21.1% (n=25) and 17.7% (n=21) under moderate and severe HR, respectively. Primary endpoints achieved were 0% in no HR group and 19% in severe HR group x² = 18.1, p <0.001). Secondary endpoints were achieved in 2.2% in no HR group and 40.7%, 56% and 100% in mild, moderate and severe HR group, respectively, ( x² = 81.1, p <0.001). HR also increased the relative risk of complications by 3.17 times (p <0.001) and death by 1.75 times (p <0.001). CONCLUSION Hypertensive retinopathy is an independent risk factor for post-acute STEMI complications in successfully thrombolysed patients and increased the relative risk for complications by 3.17 times.