© 2020 National Lipid Association Background: High-intensity statins, beta-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and antiplatelet agents (ie, intensive medical management) reduce coronary heart disease (CHD) risk after myocardial infarction (MI). Objective: The objective of the study was to determine the risk of CHD events or death despite receiving intensive medical management after MI. Methods: We studied 16,853 United States adults with health insurance in the MarketScan and Medicare databases who underwent percutaneous coronary intervention while hospitalized for MI between January 1, 2014 and June 30, 2015 and received intensive medical management within 30 days after hospital discharge. MI, CHD, and all-cause mortality rates from 30 days after hospital discharge through December 31, 2015 were compared with 67,412 individuals in each of three groups: (1) the general MarketScan and Medicare populations, (2) with diabetes, and (3) with a CHD history. Results: Among beneficiaries intensively medically managed after their MI, recurrent MI, CHD events, and all-cause mortality rates were 47.1, 72.0, and 57.5 per 1000 person-years, respectively. The multivariable-adjusted hazard ratio (95% CI) comparing intensively medically managed beneficiaries after MI to the general population, those with diabetes, and those with a history of CHD were 8.54 (7.52–9.70), 7.40 (6.61–8.28), and 5.45 (4.92–6.05), respectively, for recurrent MI; 7.82 (7.07–8.64), 6.27 (5.74–6.86), and 4.45 (4.10–4.82), respectively, for CHD events; and 1.15 (1.05–1.25), 1.05 (0.97–1.14), and 1.06 (0.97–1.15), respectively, for all-cause mortality. Conclusion: Substantial residual risk for MI and CHD events remains despite intensive medical management after MI.