Background: Heart failure with reduced ejection fraction (HFrEF) is a frequent and serious complication following acute ST-segment elevation myocardial infarction (STEMI), contributing significantly to post-infarction morbidity and mortality. Early identification of reliable biochemical predictors may enable timely intervention and improve clinical outcomes. Methods: This prospective cohort study enrolled 50 patients presenting with acute STEMI. Baseline serum iron levels were measured at admission, and patients were followed for six months to assess the development of HFrEF. Multivariate logistic regression analysis was performed to evaluate the independent predictive value of serum iron levels after adjusting for potential confounding variables. Results: At six-month follow-up, 40% of patients developed HFrEF. Baseline serum iron levels were significantly lower in patients who developed HFrEF compared with those who did not (58.4 µg/dL vs. 70.1 µg/dL; p = 0.033). Multivariable analysis revealed that each 10 µg/dL decrease in serum iron was associated with a 25% increase in the odds of developing HFrEF (adjusted odds ratio 1.25; 95% confidence interval 1.07–1.45; p = 0.005). Serum iron demonstrated a sensitivity of 60% and a specificity of 66.7% for predicting HFrEF. Conclusion: Lower serum iron levels at admission are independently associated with an increased risk of developing HFrEF within six months following acute STEMI. Routine assessment of serum iron may serve as a useful tool for early risk stratification and guide targeted post-infarction management strategies.

Serum iron, ST-segment elevation myocardial infarction, heart failure with reduced ejection fraction, prognostic marker, cardiovascular disease.