Byline: Mingzhu Xu, Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou; Lihua Yan, Department of Thoracic and Cardiovascular Surgery, Nantong First People's hospital, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.; Jialiang Xu, Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou; Xiangjun Yang, Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou; Tingbo Jiang, Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou Abstract Patients with acute myocardial infarction (AMI) complicated by heart failure with preserved ejection fraction (HFpEF) are likely to have more adverse cardiovascular events and higher mortality. The purpose of this study was to examine the predictors and outcomes in AMI patients complicated by HFpEF.We examined the demographics, clinical data, and clinical outcomes in 405 consecutive subjects who firstly presented with AMI after undergoing emergency percutaneous coronary intervention from January 2013 to June 2016.Three hundred twenty patients and eighty-five patients were classified into the nonheart failure (non-HF) group and HFpEF group, respectively. Patients with HFpEF had higher prevalence of prior hypertension, had higher levels of biomarkers, and had a larger left atrial diameter with a nondilated left ventricle were more likely to develop multivessel disease-vessels and had infarction-related artery located in left anterior descending artery than patients without HF. Moreover, patients with HFpEF had a higher probability of developing the in-hospital incident cardiovascular complications and death than non-HF patients.Two routine biomarkers, levels of hypersensitive C-reactive protein and N-terminal-pro brain natriuretic peptide, and number of diseased-vessels were independent predictors for in-hospital HFpEF incidence in AMI patients with preserved LVEF. AMI patients with HFpEF had a higher probability of in-hospital cardiovascular outcomes and mortality.