Background: Left ventricular reverse remodeling (LVRR) in patients with ST-elevation myocardial infarction (STEMI) is associated with a good prognosis. Serum levels of ADAMTS-7 might be used for the prognosis of STEMI. This study aimed to investigate the relationship between serum ADAMTS-7 levels and LVRR. Methods: This was a prospective study of 104 patients with STEMI who underwent revascularization and 63 controls. ADAMTS-7 serum levels were measured on days 1, 3, and 7 and in months 1 and 6 after STEMI. A decrease >= 15% of the left ventricular end-systolic volume at 6 months was defined as LVRR. Results: The serum levels of ADAMTS-7 in patients with LVRR were lower than those without LVRR (3.84 +/- 2.26 vs. 5.02 +/- 2.54, P = 0.032) 7 days after STEMI and the difference between day 7 and day 1 (Delta ADAMTS-7) was even significantly lower (-1.31 +/- 0.94 vs. -0.30 +/- 0.22, P = 0.021). Multivariate analysis showed that Delta ADAMTS-7((day 7 minus day 1)) was independently associated with LVRR (OR = -0.322, 95% CI = -0.996 to -0.074, P = 0.028). Receiver operating characteristic (ROC) curve analysis showed that LVRR could be predicted (sensitivity 89%, specificity 82%, and area under the curve 0.896) when Delta ADAMTS-7((day 7 minus day 1)) was < -0.39. Conclusions: Delta ADAMTS-7((day 7 minus day 1)) might be a potential predictive factor for LVRR.