Objective：To investigate the predictive value of three - dimensional speckle tracking echocardiography（3D - STE）and myocardial work（MW）on major adverse cardiovascular events（MACE）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. 3D-STE，MW assessments were performed within 24 hours following PPCI，and cardiac magnetic resonance late gadolinium enhancement imaging（CMR-LGE）was completed within 7 days post-procedure. The patients were followed up for 12 months after PPCI to track the occurrence of MACE，which inclueded recurrent angina pectoris，revascularization due to acute coronary syndrome，acute heart failure attack，and sudden cardiac death. Results：Twenty patients（22.2%）experienced MACE. Univariate and multivariate COX regression analysis showed infarction size（IS），global longitudinal strain（GLS），and global work index（GWI）as independent predictors of MACEs. The area under the curve（AUC）values for these indicators from the receiver operating characteristic（ROC）curves were 0.886，0.846 and 0.830，respectively，and pairwise comparison by Delong method showed no statistically significant difference in AUC values（all P ＞ 0.05）. The AUC value of the combined GLS and GWI in predicting MACE was 0.939，which was significantly better than either parameter alone（P ＜ 0.05），and comparable to IS（P ＞ 0.05）. Kaplan-Meier curve showed that patients with GLS＜ -10.5%，GWI ＞ 1 298.5 mmHg% and IS ＜ 26.05% had higher survival rate（P ＜ 0.05）. Conclusion： 3D-STE and MW can better predict MACE after PPCI in STEMI patients.GLS and GWI have similar diagnostic value，and their combination provides superior predictive power compared to either parameter alone，and is comparable to IS in terms of diagnostic efficiency.