Purpose <p>This was a retrospective cohort study. We examined the association between in-hospital dapagliflozin initiation and left ventricular remodeling in revascularized patients with acute myocardial infarction complicated by heart failure.</p> Methods <p>We stratified 266 revascularized AMI patients with heart failure by in-hospital dapagliflozin (10&#xa0;mg daily) after hemodynamic stabilization. Inverse probability of treatment weighting was used to balance measured baseline covariates. Weighted generalized estimating equations (GEE) tracked changes in LVEDVI over 12 months.</p> Results <p>Early dapagliflozin initiation was associated with greater reductions in ventricular volumes. By 12 months, the treatment group exhibited greater reductions in LVEDVI and LVMI (Group × Time interaction <i>P</i> &lt; 0.001), together with better LVEF recovery (56.0% vs. 48.9%). Functional status (NYHA) remained comparable between groups (<i>P</i> = 0.154). Clinically, in-hospital dapagliflozin initiation was associated with a numerical reduction in major adverse cardiovascular events (HR 0.49; 95% CI 0.23–1.04; <i>P</i> = 0.063), mainly attributable to fewer heart failure rehospitalizations.</p> Conclusion <p>In this retrospective cohort, in-hospital initiation of dapagliflozin was associated with imaging findings suggestive of favorable remodeling and fewer heart failure rehospitalizations. These hypothesis-generating findings warrant confirmation in large-scale randomized controlled trials.</p> Graphical Abstract <p></p>