ABSTRACT INTRODUCTION There is scarce information about the usefulness and prognostic value of left ventriculo-arterial coupling (VAC) in the context of acute coronary syndromes. In addition, there is a paucity of data of its use in late presenters with STEMI (12-72 hours after symptom onset). OBJETIVES In this retrospective study, we investigated the association of altered VAC with in-hospital mortality in late presenters with STEMI. Additionally, we studied the association between VAC and multiple clinical, biochemical, echocardiographic, and angiographic variables. METHODS 74 hemodynamically stable late presenters with STEMI were included. Mean age was 61.7±10.7 years, 85.1% were male. Mean LVEF was 42.8±11.3 %. VAC was estimated using transthoracic echocardiography with the single-beat method before coronary angiography. The sample was divided into two groups: 1) Patients with normal VAC (<1.36) and 2) Patients with altered VAC (>1.36). A statistically significant difference was found in the left ventricular ejection fraction (LVEF) (44.4±10.9% vs 36.2±11%, p=0.014), and in the blood urea nitrogen (BUN) level (19.45±8.00 mg/dL vs 25.45±10.40 mg/dL, p=0.02) between both groups. No statistically significant differences were found in other variables, including in-hospital mortality. CONCLUSION A higher VAC value was found (i.e., ventriculo-arterial uncoupling) in late presenters with lower LVEF and higher BUN level. No significant differences in in-hospital mortality were found. VAC may be used with point-of-care ultrasound as an approximate estimation of left ventricular systolic function in patients with late presentation STEMI, as it correlates with LVEF but is less operator-dependent. Larger studies are needed to confirm these findings.