Myocardial infarction (MI) is associated with increase in subsequent heart failure, recurrent ischemic events, sudden cardiac arrest and ventricular arrhythmias (SCA-VA). The primary objective of the study to determine the role of intercurrent heart failure and ischemic events on development of SCA-VA following first type I MI.A retrospective cohort study of patients experiencing first type 1 MI in Olmsted County, Minnesota (2002-2012) was conducted by identifying patients using medical records linkage system (Rochester Epidemiology Project). Patients aged ≥18 years were followed from the time of MI till death or July 31, 2017. Intercurrent heart failure and ischemic events were the primary exposures following MI and their association with outcome SCA-VA was assessed. Eight hundred and sixty seven patients (mean age was 63±14.5 years, 69% male, 49.8% STEMI) who had their first type I MI during the study period were included. Majority of acute MI patients were revascularized using percutaneous coronary intervention and bypass surgery (628 [72.43%] and 87 [10.03%] respectively). During a mean follow up of 7.69±4.17 years, heart failure, recurrent ischemic events and SCA-VA occurred in 155 (17.9%), 245 (28.3%) and 40 (4.61%) patients respectively. Low ejection fraction (adjusted HR 0.95, 95% CI, 0.93-0.98; P < 0.001), intercurrent heart failure (adjusted HR 3.11, 95% CI, 1.39-6.95; P =0.006) and recurrent ischemic events (adjusted HR 3.47, 95% CI, 1.68-7.18; P < 0.001) were associated with subsequent SCA-VA.SCA-VA occurred in a small proportion of patients after MI and is associated with intercurrent heart failure and recurrent ischemic events. This article is protected by copyright. All rights reserved.