Background: ST-segment elevation myocardial infarction (STEMI) remains a significant cause of death globally despite modern evidence-based medical therapies and widespread use of percutaneous coronary intervention (PCI).After percutaneous coronary intervention, the in-hospital mortality rate for STEMI is 3-4% and may approach 10% annually. In addition, individuals with STEMI had a higher risk of haemorrhage and acute renal damage, both of which were linked to worse outcomes. This research aimed to assess the predictive performance of the RISK-PCI score and the shock index (SI) in predicting major adverse cardiovascular events (MACE) and death after Primary Percutaneous Coronary Intervention. One hundred patients were studied using a variety of methods at the cardiology departments at the National Heart Institute and Benha University Hospital. History and clinical data, electrocardiogram, laboratory testing, coronary angiogram, and primary percutaneous coronary intervention were all performed on every patient. The results indicated that there was a statistically significant rise in the RISK-PCI score between patients who had MACE and those who did not (in the hospital and over the long term). There was no statistically significant difference between the two groups in terms of RISK-PCI score, despite the fact that the mean score was greater for patients who had MACE and mortality during in-hospital follow-up compared to those in the Long term group. Risk-PCI was significantly correlated with major adverse cardiac events (MACE), including death both during and after hospitalisation. Sensitivity and specificity of risk PCI score in identifying MACE incidence, long term mortality, and in hospital mortality were 95.8% and 85.7%, respectively; sensitivity and specificity of Shock Index was 85.7 and 20.7 was achieved for long term mortality and in hospital mortality. As a result, it can be concluded that the Risk PCI score and the Shock Index both have very significant predictive values for the incidence of MACE, as well as for long-term mortality and in-hospital mortality. The predictive values of major adverse cardiac events (MACEs), long-term mortality, and in-hospital mortality are all improved significantly when the Risk PCI score is embedded with the Shock Index. Whether a unique risk assessment approach may further enhance patients' prognoses after initial PCI is an issue that requires further research.