This study aimed to estimate consequences of myocardial infarction (MI) on long-term outcomes and resource needs by comparing outcomes, healthcare resource use, and associated costs between first-time MI patients and matched controls. First-time MI patients from the nationwide SWEDEHEART registry, along with matched controls without prior MI (matched by sex, age, and region) 2012-2022, were included. Follow-up continued through November 2024 and assessed major adverse cardiovascular events (MACE), defined as cardiovascular death, MI, ischemic stroke, acute limb ischemia, or urgent arterial revascularization, as well as, healthcare resource use and associated costs. Among 118,810 first-time MI patients and 588,687 matched controls, followed for a median (IQR) of 6.6 (4.2-9.4) years, the 10-year MACE probability was 48.5% vs. 21.1% (HR [95% CI] 3.65 [3.61-3.69]), mainly due to higher rate of cardiovascular death (21.7% vs. 11.1%), MI (18.4% vs. 5.9%), and arterial revascularization (22.9% vs. 4.2%). Associations attenuated after adjustment for baseline characteristics but remained significant (MACE: adjHR[95%CI]: 3.18[3.15-3.22]). Cases had twice as many inpatient visits (0.65 vs. 0.32/patient year) and inpatient days (3.05 vs. 1.67/patient year), with nearly double the mean annual total costs (€7,266 vs. €3,934) when outpatient visits and medication also were included. Differences were greatest in the first year but persisted, especially among females and those with risk factors such as hypertension or diabetes. First-time MI patients have persistently higher risks of cardiovascular death, MI, and ischemic stroke, along with greater healthcare use and costs, underscoring the need for effective prevention.