Background: We aimed to determine predictors for the occurrence and recovery of left ventricular systolic (LVS) dysfunction after acute STEMI in patients who underwent primary angioplasty (pPCI). Subjects and Methods: The study included 200 patients with acute STEMI who underwent pPCI. The patients were divided into 2 groups: Group I:102 patients with EF ≥ 50%; Group II: 98 patients with EF < 50%. Group II was subdivided into: non LVSF recovery (A) and LVSF recovery (B). All patients were subjected to history-taking, ECG [ST elevation localization of infarction and ST resolution], troponin (TnI) level, transthoracic echo in hospital and 6 months after discharge to calculate EF and pPCI to culprit artery. Results: Patients with reduced LVSF were older, had more frequent anterior infarctions, had a higher sum of STE, absent ST resolution, higher TnI, lower GFR, longer hospitalization, multi-vessel disease, and more frequent culprit LAD as compared to Group 1 patients. By multivariate analysis, we found five significant predictors of reduced LVSF: age ˃ 61.5y, KILLIP class > I, anterior infarction, multi-vessel disease, and WMSI˃1.4. Regarding LVSF recovery, patients with no LVSF recovery had higher KILLIP class ˃ I, more anterior infarctions, incomplete STR, higher TnI, and multi-vessel disease. By multivariate analysis, we found two independent predictors of LVSF recovery: TnI˂1.32 ng/ml and single-vessel disease. Conclusions: LVS dysfunction following acute MI was significantly related to old age, severe heart failure at presentation (KILLIP > I), anterior MI, multi-vessel disease, and higher WMSI. We also found that lower TnI level (a smaller extent of myonecrosis), and absence of multi-vessel disease predicted LVEF recovery 6 months after the event. Keywords: ST-elevation myocardial infarction, Percutaneous coronary intervention, Left ventricular ejection fraction, Troponin, Predictors .