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Prognosis after STEMI is still challenging. One-year mortality ranges between 10-12% and the incidence of heart failure (HF) is between 4% and 28%. Early and accurate identification of high-risk patients necessitates therapy intensification. Aim this study is a part of PREDICT-VT study (NCT03263949). The aim was to test whether deformation imaging based on spackle tracking echocardiography predict MACE (total mortality, HF hospitalization and NYHA class ≥3 development) better than conventional echocardiography and clinical parameters. Methods in 264 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done including LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec). LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strain were calculated as average of PSS over 18 LV segments. Results 198 patients completed 1-year follow-up and 22 patients (11.1%) experienced MACE. Significant echo, clinical and laboratory predictors with the ROC analysis are listed in the table according to AUC . Conclusion peak systolic longitudinal and to a lesser degree peak systolic circumferential deformation predict mortality and HF development after pPCI better than conventional echo and even clinical parameters. From diastolic parameters only radial SR during atrial contraction was better MACE predictor compared to conventional echocardiography. AUC p Cut-off Senz Spec Peak systolic LS epicardial layer 0.757 &amp;lt;0.001 -11 75 63 Radial SR during atrial contraction 0.754 &amp;lt;0.001 -0.63 65 80 Peak systolic LS mid-wall layer 0.750 &amp;lt;0.001 -12.58 80 60 PSS LS endocardial layer 0.744 &amp;lt;0.001 0.1409 70 61 Peak systolic CS endocardial layer 0.744 &amp;lt;0.001 -18.08 70 67 Wall Motion Score Index 0.740 0.001 1.53 70 70 Peak systolic CS mid-wall layer 0.730 0.001 -13.66 80 60 Peak radial LV strain 0.722 0.001 14.08 80 60 Creatine kinase peak level 0.698 0.003 2155 64 73 LV EF 0.692 0.004 47.5 67 60 TAPSE 0.685 0.015 1.95 75 60 LA strain 0.676 0.012 18.33 63 64 Killip class 0.644 0.028

570 Myocardial deformation imaging after STEMI: can we better predict one-year mortality and heart failure development?