Introduction: This study aims to explore the relationship between the Selvester QRS score and the occurrence of major adverse cardiovascular events (MACE) in athletes who have experienced an acute ST-segment elevation myocardial infarction (STEMI) and undergone percutaneous coronary intervention (PCI). Given the physical demands placed on athletes, understanding this correlation is crucial for assessing risks and tailoring post-PCI rehabilitation protocols to optimize their return to sports participation. Methods: We retrospectively analyzed data from STEMI patients, including athletes, who received PCI between January 2016 and May 2018. Patients were stratified into two cohorts based on the occurrence of MACE within a 3-year follow-up period. The Selvester QRS score was evaluated for its potential to predict MACE in this specific population. Results: Among the 468 patients enrolled, 24.79% (n=116) experienced MACE. Notably, the Selvester QRS score was significantly elevated in the MACE group compared to those without MACE (p<0.0001). Multivariate logistic regression identified the Selvester QRS score as an independent predictor of MACE (OR = 1.235, 95% CI = 1.093-1.394, p = 0.001). ROC curve analysis confirmed the diagnostic utility of the Selvester QRS score, with an optimal cut-off value of 6.5 indicating heightened risk (sensitivity 42%, specificity 84%, AUC 0.669). Patients with a Selvester QRS score greater than 6.5 exhibited a markedly increased risk of MACE versus those with a score below this threshold (p<0.000). Conclusions: The Selvester QRS score serves as a valuable prognostic tool for predicting MACE in athletes following PCI for STEMI. This finding underscores the importance of incorporating advanced cardiac assessments into the management and rehabilitation plans for athletic patients post-PCI, facilitating safer decisions regarding the timing and extent of their return to competitive physical activity.