Echocardiography is an imaging technique of paramount importance for the management of patients with ST-elevation myocardial infarction. In particular, this technique may be useful for diagnosis and is essential for prognosis and to guide drug therapy. The role in the recognition of mechanical complications and in the identification and management of other complications such as pericarditis and left ventricular thrombosis is also crucial. Finally, echocardiography offers important information for the prediction of the arrhythmic risk and the study of left ventricular remodeling. In recent years, speckle-tracking echocardiography has been added to conventional echocardiographic techniques, showing additional value for diagnostic and prognostic indications, but further confirmations are needed.