Aim To observe the changes in indexes of ventricular remodeling and adverse drug reactions in patients with acute myocardial infarction (AMI) before and after treatment, and evaluate the efficacy and safety of different doses of sarcubatrix/valsartan in the treatment of heart failure patients after AMI. Methods 174 patients with acute ST-segment elevation myocardial infarction (STEMI) and subnormal left ventricular ejection fraction (LVEF) ＜50% from March 2018 to March 2022 were randomly allocated to receive maximal tolerated dose of sacubitril/valsartan (titrated up to maximal tolerated dose or 200 mg, Bid, n＝80) or low dose sacubitril/valsartan (50 mg, Bid, n＝94) treatment, they also received conventional treatment. The changes in echocardiographic parameters, serum N-terminal pro-brain natriuretic peptide(NT-proBNP) and adverse drug reactions (symptomatic hypotension, hyperkalemia, kidney function decline and angioedema, et al) from baseline to 12 months after discharge were assessed. Results After treatment, there was statistically significant difference in left atrial diameter (LAD) of maximum tolerated dose group and low dose group compared with baseline (P＜0.05), however, there was no statistically significant difference between the two groups (P＞0.05). The left ventricular end diastolic diameter (LVEDD) were significantly decreased in two groups compared with baseline (P＜0.05), but there was no statistically significant difference between the two groups (P＞0.05). The left ventricular ejection fraction(LVEF) were significantly increased in both groups compared with baseline (P＜0.05), but there was no statistically significant difference between the two groups (P＞0.05). The decrease of serum NT-proBNP levels was higher in maximum tolerated dose group than that in low dose group (P＜0.05). The incidence of drug-related adverse reactions was higher in the maximum tolerated group (17.5% vs 2.1%, P＜0.05). Conclusion Compared with low dose sacubitril/valsartan group, the maximum tolerated dose group did not show significant advantages in improving cardiac remodeling and LVEF. Although it may be possible to reduce cardiovascular events by further reducing NT-proBNP levels, strict titration of the maximum tolerable dose was closely related to frequent adverse drug reactions.