Acute ST-segment elevation myocardial infarction (STEMI) still affects people's health due to its high prevalence and high mortality rate. Electrocardiogram (ECG), as a commonly used non-interventional type of examination, has unique pathophysiological and clinical significance. Here we list the significance of QRS wave for early diagnosis and prognostic assessment in STEMI patients, such as QRS duration, QRS-T angle, QRS distortion, fragmented QRS, QRS scores, R wave peak time, triangular QRS-ST-T waveform, QRS low voltage, etc. Some of these metrics are old, such as the QRS score, QRS duration, for which we list the results of recent studies. Some are newer metrics, such as the fragmented QRS, QRS distortion, for which we summarize the results to date. This article aims to highlight its role in diagnosis and prognostic evaluation, guide clinical practice, and provide new ideas for future scientific research.