| Summary: | Acute ST-segment elevation myocardial infarction (STEMI) activates inflammation that can contribute to left ventricular systolic dysfunction (LVSD) and heart failure (HF). The objective of this study was to examine whether high-sensitivity C-reactive protein (CRP) concentration is predictive of long-term post-infarct LVSD and HF. In 204 patients with a first STEMI, CRP was measured at hospital admission, 24 h (CRP<sub>24</sub>), discharge (CRP<sub>DC</sub>), and 1 month after discharge (CRP<sub>1M</sub>). LVSD at 6 months after discharge (LVSD<sub>6M</sub>) and hospitalization for HF in long-term multi-year follow-up were prospectively evaluated. LVSD<sub>6M</sub> occurred in 17.6% of patients. HF hospitalization within a median follow-up of 5.6 years occurred in 45.7% of patients with LVSD<sub>6M</sub> vs. 4.9% without LVSD<sub>6M</sub> (<i>p</i> < 0.0001). Compared to patients without LVSD<sub>6M</sub>, the patients with LVSD<sub>6M</sub> had higher CRP<sub>24</sub> and CRP<sub>DC</sub> and persistent CRP<sub>1M</sub> ≥ 2 mg/L. CRP levels were also higher in patients in whom LVSD persisted at 6 months (51% of all patients who had LVSD at discharge upon index STEMI) vs. patients in whom LVSD resolved. In multivariable analysis, CRP<sub>24</sub> ≥ 19.67 mg/L improved the prediction of LVSD<sub>6M</sub> with an increased odds ratio of 1.47 (<i>p</i> < 0.01). Patients with LVSD<sub>6M</sub> who developed HF had the highest CRP during index STEMI. Elevated CRP concentration during STEMI can serve as a synergistic marker for risk of long-term LVSD and HF.
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