Background: The SMART residual risk (RR) score, used to estimate the 10-year risk for myocardial infarction, stroke or vascular death in patients with clinically manifest atherosclerotic vascular disease, appears to be important at each stage of patients supervision. The aim was to highlight the evolution of RR in patients with ischemic heart failure (HF) after myocardial revascularization. Methods: Our study included 80 surviving patients who underwent myocardial revascularization by aorto-coronary bypass grafting (76.3%) or primary percutaneous coronary angioplasty (23.8%). The mean age was 62.05 ±6.54 years, 80 % being men. They were monitored on average 28.8 months. RR was calculated for all patients at the initial and final stage of the research. Results: The mean value of the RR at the initial stage was 17.75 ± 12.72%, while at the final stage it increased significantly, constituting 19.37 ± 11.77% (p<0.01). Many patients with moderate RR (87.7%) were found to remain largely in the same risk category, p<0.001. However, in the high risk group, the rate of patients who held the position was 45.5%, when others 36% obtained a very high risk at the follow-up (x2=63.77; p<0.001). Most patients with very high risk did not show an improvement of RR (83%, p <0.001). The majority of patients with HF NYHA II functional class (f.c.) with moderate or very high RR remained in the same risk group (92.7% and 85.7%, x2=49.72; p<0.001), while an improvement is noted in 33.3% of patients with high residual risk, p <0.001. In patients with HF NYHA III f.c. the RR increased, especially in the high risk category, where 60% go to the very high risk group (x2=19.5; p<0.01). Only in subgroup of patients with HF mid-range ejection fraction was noted a significant increase of RR by 2.77% (p<0.05) during the surveillance period. Conclusions: The RR in patients with ischemic HF in the post-myocardial revascularization period slowly increases during the first two to three years, on the applied secondary prevention therapy. The most important advancement of RR occurred in patients with HF NYHA III functional class and in subgroup with HF mid-range ejection fraction.