Background; The BNP level changes dramatically during the period after the onset of AMI, identification of a suitable sampling time and prognosis prediction is problematic. We examined serial change pattern of BNP level and whether the BNP level measured serially after the onset of AMI represents a reliable long-term prognostic marker for patients with AMI. Methods; From Feb 2002 to May 2005, we analyzed 318 consecutive AMI patients with BNP examinations. Serial BNP levels (Triage짰) were measured on admission (< 24 hr, Q1), early period (24hr -6day, Q2)), late period (7 to 29 day, Q3) & long-term period (��� 30day, Q4) after onset of AMI. The end-point was cardiovascular death (CVD). We compared with clinical and biochemical profile between in survive group and in CVD group. Results; Mean age was 69짹13 and male was 56.9%. Killips grade I / II was 58.5 and 18.5 %. Anterior AMI was 43.3%. The mean follow-up period was 20.6 months. Mean BNP levels were significant difference among the each period (360짹788 in Q1 (n=318), 531짹1061 in Q2 (n=60), 394짹618 in Q3 (n=105) and 148짹336 in Q4 (n=235), p=0.000). BNP levels depend on time-dependant manner (Q1, Q2) was significant higher in patients with anterior AMI than in patients with inferior AMI (p<0.05, respectively). Of those patients, 38 experienced CVD (11.9 %) during this study. Age (p=0.00), Cr (p=0.029), BNP in Q1 (p=0.000), Q2 (p=0.001) and EF (p=0.042) were significantly higher in the CVD group. A univariate analysis showed that Age (p=0.043), CK-MB (p=0.017), Troponin (p=0.045), BNP in Q1 (p=0.216) and Q2 (p=0.005) were an independent predictor of cardiac death. On the receiver operating characteristic curve, the best value of BNP (Q2) in prediction for CVD risk was 124.5 pg/ml (accuracy 87.0 %, p=0.00). Conclusions; The BNP levels revealed changes in time dependent manner after AMI. Especially, BNP levels obtained early period (24hr to 6 day) after the onset of AMI can be used as a powerful independent predictor of CVD in patients with AMI.