Background: Acute ST-segment elevation myocardial infarction [STEMI] results in left ventricular adverse remodeling [LVR]. Increased left ventricular wall stress [LVWS] after Myocardial infarction [MI] initiates this process. Predicting the risk of future major adverse cardiovascular events [MACE] after STEMI has been a subject of great interest. There is a lack of imaging-based data for risk stratifying post-STEMI patients' clinical outcomes at this time. As a result, improvements in echocardiography are urgently needed to identify objectively measurable echocardiographic markers for improved risk stratification.
The Aim of the work: This study aimed to study the relation between echocardiography-derived LVWS in non-diabetic patients presented with first acute anterior STEMI who underwent primary percutaneous coronary intervention with the MACE.  
Patients and Methods: The current study was a prospective cohort study that took place between January 2022 and November 2022 and included 78 non-diabetic patients who presented with acute anterior STEMI treated by primary PCI. LVWS was calculated within 72 hours by pre-discharge echocardiogram using volume-based formulas. Patients were divided into two groups based on their three months follow-up data following primary PCI; Group I: MACE-negative, and Group II: MACE-positive.
Results: MACE-positive patients [n=18] had significantly higher end-systolic wall stress [ESWS] levels 94.95 ± 31.27 vs 77.20 ± 24.37 in MACE-negative patients [P value = 0.013*]. A receiver operating characteristics [ROC] curve was performed for the ESWS [KPa] as a predictor for MACE. The findings revealed an area under the curve of 0.674, the cut-off value for predicting MACE = 85.35 [KPa], with 66.97% sensitivity, 65% specificity, 86.7% Negative predictive value, 36.4 % positive predictive Value [P value = 0.026].
Conclusion: Echocardiography-based left ventricular systolic wall stress is a possibly useful prognostic tool for risk-stratifying non-diabetic STEMI patients early after MI and predicting MACE.