To investigate the correlation of neutrophil to high density lipoprotein cholesterol ratio (NHR) and monocyte to high density lipoprotein cholesterol ratio(MHR) for concurrent heart failure during hospitalization in patients with acute ST-segment elevation myocardial infarction. Methods We selected 274 patients with acute ST segment elevation myocardial infarction (STEMI) admitted from June 2020 to December 2021. It was divided into 98 cases in the heart failure group and 176 cases in the nonheart failure groups. Patient clinical data were collected, After admission and at 24 hours of admission, blood cell counts, random blood glucose (GLU), creatine kinase isoenzyme (CK-MB), troponin I (TnI), blood lipid, N-terminal brain sodium peptide precursor (NT-proBNP), and soluble tumor factor 2 inhibitor (sST2) were measured. Calculate the NHR, MHR. Left ventricular ejection fraction (LVEF) was determined after admission and before discharge. Results There were no statistical differences between sex, weight, random blood sugar, total cholesterol (TC), trionyglycerol (TG), low density lipoprotein (LDL), and underlying disease (P＞0.05). Significant differences in the heart failure group age, blood cell count, GRACE score at admission, onset to first visit were higher than the non-heart failure group, and high-density lipoprotein (HDL) were lower than the non-heart failure group (P＜0.01). NHR, MHR, TnI, CK-MB were higher than in the 24h, and post-admission to heart failure group, and was statistically different when compared to 24h after admission (P＜0.05). After admission, the two groups of NT-proBNP, sST2 levels were compared, and the differences were not statistically significant (P＞0.05). The 24h, heart failure group was higher than non-heart failure and was statistically significant (P＜0.01). At 24h after admission, the LVEF was not different (P＞0.05), LVEF was lower before discharge than non-heart failure, and LVEF was lower than 24h after admission, which showed a significant difference (P＜0.01). In the grade Killip Ⅳ group, the comparison between NHR, MHR, TnI, CK-MB, NT-proBNP, and sST2 higher than grade KillipⅡ and grade KillipⅢ groups, The KillipⅢ group was higher than the Killip Ⅱ group, which was statistically significant (P＜0.05). Correlation analysis: A negative correlation between NHR, MHR and LVEF in STEMI patients. (r=- 0.696, P=0.001; r=- 0.715, P=0.01). Logistic regression analysis: At 24h after admission, patients with STEMI with NHR, MHR, NT-proBNP, sST2 and multiple branches of coronary artery had an increased risk of complicated heart failure during hospitalization. ROC results showed that the area under the 24h, NHR, MHR joint detection curve after admission was 0.765 after admission, which had a greater predictive value for concurrent HF during the STEMI hospital. Conclusion The joint detection of NHR and MHR is associated with concurrent heart failure during STEMI hospitalization, being of predictive value for prognosis, and facilitated the identification and judgment of high-risk patients with concurrent heart failure during STEMI hospitalization