Objective <p>This study aims to investigate the relationship between segmental longitudinal strain (LS) and quantitative microvascular perfusion (qMVP) in patients with ST-segment elevation myocardial infarction (STEMI), and to explore the prognostic value of the two indicators after STEMI.</p> Methods <p>The retrospective study enrolled 61 patients who underwent primary percutaneous coronary intervention (pPCI) for first STEMI. Microvascular perfusion (MVP) and qMVP were analyzed by myocardial contrast echocardiography (MCE), and segmental LS was analyzed by two-dimensional speckle tracking echocardiography (2D-STE). Myocardial wall perfusion was qualitatively assessed visually. Quantitative myocardial perfusion parameters were analyzed using an 18-segment model. The correlation between segmental LS and qMVP was assessed. The prognostic value of segmental LS and qMVP for major cardiac adverse events were evaluated.</p> Results <p>Among the 314 segments with abnormal wall motion, 44 showed normal microvascular perfusion (nMVP), 87 showed delayed microvascular perfusion (dMVP), and 183 exhibited microvascular obstruction (MVO). Segmental LS was correlated with segmental wall motion (WM) and qMVP. At 12-month follow-up, 19 patients experienced cardiac events. NT-proBNP, regional LS (rLS), and regional qMVP (r-qMVP) were associated with cardiac events. The area under curve (AUC) of combination of rLS and r-qMVP was bigger than single indicator for identifying prognostic value (<i>P</i> &lt; 0.001).</p> Conclusion <p>Segmental LS indices are correlated with qMVP within the infarct zone following reperfused STEMI. Both rLS and r-qMVP are sensitive to myocardial damage and provide prognostic value for clinical events after STEMI. And the combination of rLS and r-qMVP shows improved predictive ability compared to a single indicator.</p> Graphical Abstract <p></p>