Background It is important to identify patients that are at high risk following primary percutaneous coronary intervention (P-PCI) for the treatment of ST-segment elevation myocardial infarction (STEMI). Left ventricular ejection fraction (LVEF) is the most important parameter obtained from transthoracic echocardiography (TTE) for risk stratification. The authors evaluated the value of pulmonary artery pressure (PAP) and left atrial volume index (LAVI) for the prediction of major adverse cardiovascular events (MACE) in patients with STEMI that underwent P-PCI. Methods A total of 92 patients that underwent P-PCI for STEMI were included in the study. All patients underwent TTE examination before discharge. The composite primary outcome of the study was all-cause mortality and new onset heart failure (HF) during an 8-year follow-up period. Results The mean age of patients was 61.6 +/- 12.4 years and 15 were female (16.3%). Major adverse cardiovascular events (MACE) defined as all-cause mortality and new onset HF occurred in 30 (41%) patients during a mean of 6 +/- 2.7 years of follow-up. In the backward multivariate Cox regression analysis LVEF (odds ratio [OR] = 0.933, 95% confidence interval [CI]: 0.876-0.994,p = 0.031), LAVI (OR = 1.069, 95%CI: 1.017-1.124,p = 0.009), PAP (OR = 1.137, 95% CI: 1.057-1.223,p = 0.001) and creatinine level (OR = 1.730, 95% CI: 1.350-1.223,p = 0.029) were found to independently predict MACE during long-term follow-up. Receiver operating characteristic (ROC) curve analysis was performed, revealing that sPAP >24.5 mm Hg had a sensitivity and specificity of 72 and 66%, respectively; LAVI >31 ml/m(2)had a sensitivity and specificity of 72.2 and 83.3%, respectively. Conclusion In patients that underwent P-PCI for the treatment for STEMI, LVEF, LAVI, PAP and creatinine level independently predicted all-cause mortality and new onset HF during long-term follow-up.