Abstract: Objective To analyze the correlations of D-dimer and the Global Registry of Acute Coronary Events (GRACE) score with long-term heart failure (HF) in patients with acute myocardial infarction (AMI). Methods A total of 398 patients with AMI were selected as research objects and divided into normal D-dimer group (n=309) and elevated D-dimer group (n=89) based on the D-dimer level. Cox proportional hazard model was used to analyze the risk factors for long-term HF in both groups. Time-dependent receiver operating characteristic (ROC) curve was used to analyze the values of D-dimer, GRACE score and their combination in predicting long-term HF. According to the GRACE score and D-dimer level, 398 patients were divided into low-value group (181 patients with normal D-dimerand low GRACE score), high-value group (70 patients with elevated D-dimer and high GRACE score), and middle-value group (147 patients did not meet the conditions of the low-value and high-value groups). Kaplan-Meier method was used to analyze the occurrence of long-term HF in the three groups. Point-biserial analysis was used to analyze the correlation between elevated D-dimer and the occurrence of long-term HF. Results The number of patients with long-term HF in the elevated D-dimer group was 2.3 times of the normal group. D-dimer and GRACE score were independent risk factors for long-term HF in patients with AMI (P<0.05). Both D-dimer and GRACE score had certain predictive values for the occurrence of HF at 5 years after AMI, but the predictive efficiency of GRACE score was better. The incidence of long-term HF in the high-value group was significantly higher than that in the low-value group and the middle-value group (P<0.01). D-dimer was significantly positively correlated with the occurrence of long-term HF after AMI (P<0.001). Conclusion Both D-dimer and GRACE score are independent risk factors for long-term HF in patients with AMI, and the two indexes have certain predictive value for the occurrence of long-term HF. Patients with both elevated indicators are high-risk groups for long-term HF.