Objective: To investigate the predictive value of three-dimensional speckle tracking echocardiography (3D-STE) and myocardial work (MW) on major adverse cardiovascular events (MACEs) in patients with acute ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Methods: Ninety patients with first concurrence of STEMI and treated with PPCI were enrolled and underwent 3D-STE, MW examination within 24 hours following PPCI and cardiac magnetic resonance late gadolinium enhancement imaging (CMR-LGE) within 7 days post-procedure, and were followed up for 12 months after PPCI. The primary endpoint was the MACE (a composite of recurrent angina pectoris, revascularization due to acute coronary syndrome, acute heart failure attack, and sudden cardiac death). Results: MACEs occurred in 20 (22.2%) patients. The univariate and multivariate COX regression analysis revealed that infarction size (IS), global longitudinal strain (GLS), and the global work index (GWI) were independent parameters for predicting MACEs. The AUCs of the above indexes were 0.886, 0.846, and 0.830, respectively, without significant statistical differences within groups (all P > 0.05). Kaplan-Meier analysis showed that the survival rate patients was significantly higher with GLS < -10.5%, GWI > 1298.5mmHg%, IS < 26.05 (P< 0.05). Conclusion: 3D-STE and MW are good predictors of MACEs in STEMI patients after PPCI, while the diagnostic value of GLS and GWI is similar and comparable to CMR-IS.