Vericiguat in the Management of De Novo Acute Decompensated Heart Failure after Acute Myocardial Infarction: A Single-Center Pilot Cohort Study

Background: The role of vericiguat in worsening chronic heart failure with reduced ejection fraction (HFrEF) is well established. However, its safety and role in managing de novo acute decompensated heart failure (ADHF) immediately following acute myocardial infarction (AMI) remain largely unknown. Methods: In this single-center, retrospective pilot cohort study conducted from November 2023 till December 2025, we screened 145 patients admitted with de novo ADHF following AMI. A total of 106 consecutive patients who received early oral vericiguat within 48 hours of admission alongside guideline-directed medical therapy (GDMT) were enrolled. After excluding 5 patients who died during the index admission or follow-up, 101 survivors were evaluated at 7 days and 3 months post-discharge for clinical, echocardiographic, and laboratory changes. Results: The analytic survivor cohort (n = 101) had a mean age of 56 ± 10 years and 85% were male. All had severe ADHF (100% requiring intravenous diuretics, 80% cardiogenic shock requiring inotropes). Over 3 months of vericiguat and GDMT administration, New York Heart Association (NYHA) functional class improved significantly (class III/IV at baseline down to 10% class III and 90% class II; P < 0.01). Mean left ventricular ejection fraction (LVEF) increased from 30.5% ± 8.5% to 36.6% ± 6.4% (P < 0.05). Prevalence of hypotension decreased from 80% to 10% (P < 0.01). Renal function (eGFR) improved over time. No adverse effects leading to vericiguat withdrawal were observed. Conclusions: In this pilot cohort, vericiguat administered with GDMT was well tolerated in patients with post-AMI de novo ADHF and was associated with short-term clinical and hemodynamic improvement.