It is still a matter of debate which patients with acute inferior myocardial infarction are at increased risk of developing right ventricular (RV) myocardial infarction (RVMI). Cardiac magnetic resonance imaging (CMRI) with late enchancement (LE) is regarded as the gold standard for RVMI assessment. We aimed to determine the impact of initial angiographic status and salutary effect of primary percutaneous coronary intervention (PCI) on the presence of RVMI. In 114 patients undergoing emergency angiography and primary PCI of right coronary artery, 3–5 days after index PCI, LE CMRI was performed for assessing the RVMI. Forty-eight patients (42 %) demonstrated RVMI. Multivariate regression analysis identified TIMI flow <2 in at least one RV branch after PCI as an independent angiographic predictor of RVMI [odds ratio (OR) 143.00, 95 % confidence interval (CI) 18.10–1130.05, p < 0.001]. ST-segment elevation ≥1 mm in V4R was present in 83 (73 %). TIMI flow <3 in at least one RV branch before PCI (OR 4.07, 95 % CI 1.24–13.33, p = 0.02) was independent angiographic predictor of ST-segment elevation ≥1 mm in V4R. The only predictor of RVMI was TIMI flow <2 in at least one RV branch after PCI. ST-segment elevation ≥1 mm in V4R is caused by TIMI <3 flow in at least one RV branch before index PCI.