Left ventricular end-diastolic pressure (LVEDP) is an important measure of ventricular performance and may identify patients at increased risk for developing late clinical symptoms of heart failure (HF). The primary outcome in this analysis of 744 patients from the Survival and Ventricular Enlargement (SAVE) trial was the development of death or HF over a mean time of 36 months. The mean LVEDP for all patients was 23+/-9 mm Hg, and 75% of participants (n=558) had an LVEDP >15 mm Hg. Patients with an LVEDP >30 mm Hg (n=187) had the highest risk of death or HF (unadjusted hazard ratio, 1.40; 95% confidence interval [CI], 1.00-1.97) when compared with the other 2 cohorts combined (n=603). After adjustment for other known predictors of cardiac risk, LVEDP no longer remained significant (adjusted hazard ratio, 1.12; 95% CI, 0.77-1.65). Elevated LVEDP is common following myocardial infarction; however, it is not an independent predictor of subsequent HF risk. The variability in LVEDP is not fully explained by infarct size and atherosclerotic burden.