Abstract: We sought to assess the ability of The Myocardial Performance Index (MPI), measured at entry, to predict in-hospital cardiac adverse events in a series of patients with first Acute Myocardial Infarction (AMI). A complete 2-dimential and Doppler echocardiographic examination was performed within 24 h of arrival at the coronary care department in 78 patients (61 men and 17 women; mean age 58�2 years) with first AMI. Patients were divided later into 2 groups according to their in-hospital course: group 1 comprised 46 patients with an uneventful course and group 2 comprised 32 patients with a complicated in-hospital course (death, heart failure, arrhythmias, post-AMI angina or Re MI). There were no significant differences between the 2 groups with regard to history of hypertension, diabetes mellitus, hypercholesterolemia, cardiac enzymes and response to thrombolytic, however patients with lateral MI more commonly had events (26 vs. 15%; p= 0.01) and those who received thrombolytic had less events (32 vs. 66%; p=0.01). Echocardiographic findings showed significant difference in Left Ventricle Ejection Fraction (LVEF) (40� 8% vs. 33�2%; p=0.005) between two groups; however, MPI showed no significant difference between two groups (0.50�0.14 vs. 0.47�0.16; p= 0.43) and we did not find any cut point with acceptable sensitivity and specificity for predicting in-hospital complications. E wave acceleration time at 91ms showed a sensitivity of 87 and specificity of 78 and in factor analysis the component comprising of LVEF, Left Ventricle End-Systolic Diameter (LVESD), ratio of early to late peak velocities (E/A), E-wave Deceleration Time (EDT), Isovolumic Relaxation Time (IVRT) showed sensitivity of 87 and specificity of 67%. Our findings suggest that in the acute phase of AMI, the MPI measured in admission cannot be a useful to predict which patients are at high risk for in-hospital cardiac events.