| Background:ST-segment elevation myocardial infarction (STEMI) survivors face a significant residual risk of developing heart failure (HF) owing to maladaptive left ventricular (LV) remodeling. Sodium-Glucose Cotransporter-2 inhibitors (SGLT2i) are established pillars of care for chronic HF.Methods: This double-blind, placebo-controlled, prospective, randomized, single-center trial, enrolled 104 patients with confirmed STEMI and randomized them to be treated with either dapagliflozin (DAPA) 10 mg daily (n=73) or a matching placebo (n=31), in addition to standard guideline-directed therapy. Echocardiographic parameters, including LV Ejection Fraction (LVEF), Global Longitudinal Strain (GLS), and LV volumes, were assessed. All patients were assessed at the following time points: baseline (at admission), 30 days, and following 6 months.Results: At the 6-month follow-up, patients treated with DAPA exhibited superior cardiac function, with higher median LVEF (50% vs. 45%, p=0.002) and improved GLS (-12.0% vs. -10.9%, p=0.022). Notably, adverse LV remodeling was prevented entirely in the dapagliflozin group (0%) relative to 100% in the placebo group (p<0.001). Consequently, the total risk of MACE at 6 months was significantly reduced in the dapagliflozin group (15.1% vs. 38.7%, p=0.011), a benefit primarily driven by a reduction in HF-related hospitalizations (HFH) (6.8% vs. 25.8%, p=0.019), with comparability in cardiovascular mortality.Conclusion: Early upstream initiation of DAPA in patients presenting with STEMI can effectively improve clinical outcomes, as evidenced by reduced MACE and HFH incidence, and improve echocardiographic parameters, as evidenced by improved LV remodeling protection, longitudinal strain, and EF..