Background: The objective of the present study was to evaluate the relationship between echocardiographic epicardial fat and serologic parameters in patients with acute myocardial infarction (AMI). Methods: A total of 513 consecutive patients (62.4짹12 years, 361 males) with AMI were divided into two groups according to the of epicardial fat thickness; group I associated with higher thickness more than 3 mm (n= 213, 65.9 짹 11 years, 137males) vs. group II associated with lower thickness less than 3 mm (n=300, 59.9 짹 13 years, 224 males). Various clinical, laboratory, echocardiographic parameters and coronary angiographic findings were compared between two groups. Results: Age and abdominal circumference was higher in group I than group II. The prevalence of diabetes, smoking and multi-vessel disease was more frequent in group I than group II. The levels of glucose and C-reactive peptide (hs-CRP) were significantly increased in group I than in group II (p<0.001). Left atrial contraction velocity, left ventricular filling pressure and wall motion score index was higher in group I than in group II (p<0.001). Acute in-hospital event rate and one-year major adverse cardiac event rate were no significant difference between two groups. Conclusions: Epicardial fat is closely related with cardiovascular risk factors and associated with echocardiographic parameters, but is not affected short- and long-term clinical outcomes in patients with AMI.