Objective To investigate the changes in parameters of conventional echocardiography and three-dimensional speckle tracking imaging（3D-STI） in patients with acute myocardial infarction（AMI） after percutaneous coronary intervention（PCI），and analyze their predictive efficacy and clinical significance for the occurrence of major adverse cardiovascular events（MACE）.Methods A total of 98 patients with AMI admitted to our hospital were selected and divided into the MACE group and the non-MACE group according to the occurrence of MACE within 3 months after PCI. All patients underwent routine echocardiography and 3D-STI examination within 24 hours after PCI to obtain left ventricular end-systolic diameter (LVESd), left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), left ventricular end-systolic volume (LVESV), left ventricular end-diastolic volume (LVEDV), rotation angle, torsion angle, global longitudinal strain (GLS), global area strain (GAS), global circumferential strain (GCS), and global radial strain (GRS). The correlation between each parameter and the occurrence of MACE was analyzed, and the importance of MACE warning factors was ranked. The receiver operating characteristic (ROC) curve was drawn to analyze the predictive efficacy of each parameter on the occurrence of MACE. Results The LVEF, rotation angle, torsion angle, GLS, GAS, GCS, and GRS in the MACE group were lower than those in the non-MACE group, and the differences were statistically significant (all P<0.05). There was no significant difference in LVESd, LVEDd, LVESV, and LVEDV between the two groups. Correlation analysis showed that LVEF, rotation angle, torsion angle, GLS, GAS, GCS, and GRS were negatively correlated with MACE (all P<0.05); the importance of MACE warning factors was ranked as follows: GLS, GRS, GAS, GCS, rotation angle, torsion angle, and LVEF. ROC curve analysis showed that the area under the curve for predicting the occurrence of MACE using LVEF, rotation angle, torsion angle, GLS, GAS, GCS, and GRS in combination was 0.914, which was greater than that of each parameter used alone (all P<0.05). Conclusion Patients with AMI who have MACE after PCI have decreased LVEF，rotation angle，torsion angle，GLS，GAS，GCS，and GRS.Combined detection of these parameters has certain predictive value for the occurrence of MACE，and may provide an important evaluation tool for early clinical diagnosis of cardiac function impairment after PCI.