Background: The relationship between ST-segment elevation (STE) resolution and 30-day mortality has been evaluated, although limitedly, in non-Indian patients undergoing primary percutaneous coronary intervention (pPCI). We aimed to evaluate the prognostic utility of STE resolution in predicting 30-day mortality in Indian patients undergoing pPCI for ST-elevation myocardial infarction (STEMI).Materials and methods: This prospective, single-center, observational study investigated the correlation between 30-day mortality rate and extent of STE resolution in real-world Indian patients undergoing pPCI for STEMI. A total of 64 patients underwent pPCI for STEMI at a tertiary care center in India. The patients were classified into three groups based on the extent of STE resolution: complete resolution (≥70%), partial resolution (30-70%), and no resolution (<30%). The primary endpoint of the study was occurrence of major adverse cardiovascular events consisting of all-cause death, reinfarction, disabling stroke, and ischemia-induced target vessel revascularization at 30 days follow-up.Results: The study enrolled 56 patients. The mean age of patients was 59.7±6.8 years and there were 46 (82.1%) males. Complete STE resolution (≥70%) occurred in 7.1%, partial resolution (<70-30%) in 82.1% and no resolution (<30%) in 10.7%. The mortality rate was 2.1% and 33.3% in patients with partial and no STE resolution. No mortality was seen in patients with complete STE resolution. The 30-day survival analysis revealed significant differences between the three groups (P<0.01). STE resolution served as an independent predictor of 30-day mortality across all clinical variables, including patients with post-PCI thrombolysis in myocardial infarction (TIMI) 3 flow.Conclusions: Persistent STE after PCI is a reliable indicator of 30-day mortality in real-world STEMI patients. The extent of STE resolution can be used as a simple and affordable tool to stratify patients by the risk of mortality soon after the acute event. Due to their higher mortality at 30 days follow-up, individuals with persistent STE should be the focus for further treatment interventions.