Background: People with type 2 diabetes (T2DM) face a markedly elevated risk of cardiovascular complications and death. Among contemporary glucose lowering drugs, sodium glucose cotransporter 2 inhibitors (SGLT2i) have exhibited broad cardio renal benefits, lowering rates of heart failure admission, major adverse cardiovascular events (MACE), as well as kidney injury. Objective: This study explored whether starting an SGLT2i during hospitalization improves clinical and echocardiographic outcomes in T2DM patients experiencing their first acute anterior ST elevation myocardial infarction (STEMI) managed utilizing primary percutaneous coronary intervention (PPCI). Patients and Methods: Between June and December 2023, 115 consecutive candidates for PPCI who had never used SGLT2i were enrolled. After reperfusion, the treating physician either initiated dapagliflozin 5 mg once daily with the ongoing antidiabetic regimen (Group I) or maintained standard therapy alone (Group II). Ninety-eight participants completed 6-month follow-up. Results: Compared with Group II, Group I exhibited significant 6-month reductions in left ventricular end diastolic diameter, end systolic diameter, end systolic volume index, and left atrial volume index. The incidence of MACE was numerically higher in Group II, though not statistically different, and rates of contrast induced nephropathy were similar. Notably, clinically important arrhythmias occurred less often in Group I. Conclusion: Initiating SGLT2i therapy soon after primary PCI for anterior STEMI in patients with well controlled T2DM was associated with fewer cardiovascular events involving all-cause mortality, heart failure hospitalization, as well as MACE and with meaningful improvements in cardiac chamber dimensions and function