Background and Objectives : Elevated levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP), troponin I or high-sensitivity C-reactive protein (hs-CRP) each are associated with higher rates of death and recurrent myocardial ischemia in patients with acute coronary syndrome (ACS). Importantly, these 3 biomarkers assess different pathophysiological mechanisms in myocardial ischemia. We evaluated the comparative prognostic value of NT-proBNP, troponin I and hs-CRP and aimed to find out that multimarker risk approach would provide complementary prognostic information. Subjects and Methods : We included 287 patients who were admitted for ACS between January and December, 2006. We measured NT-proBNP and hs-CRP within 24 hours after admission and troponin I on admission. Troponin I was followed within 12 hours at the discretion of physician. Patients were followed for 559 days in median concerning cardiovascular events including death, new myocardial infarction, heart failure or rehospitalization for ACS. Results : NT-proBNP was the most powerful predictor of clinical outcomes among biomarkers (HR 3.73, 95% CI 2.16-6.43), followed by peak troponin I and hs-CRP (HR 2.15, 95% CI 1.16-4.00; HR 2.08, 95% CI 1.23-3.51, respectively), but not baseline troponin I. After adjusting for clinical factors and other biochemical markers, NT-proBNP was the only independent predictor of adverse events (HR 3.49, 95% CI, 1.86-6.55), but not peak troponin I and hs-CRP. Multimarker risk approach including NT-proBNP, hs-CRP and peak troponin I was significantly associated with adverse events, especially with the presence of three positive biomarkers (adjusted HR 4.20, 95% CI 1.39-12.67). Conclusion : NT-proBNP is the most powerful and independent predictor of clinical outcomes among cardiac biomarkers. Because peak troponin I levels provide more prognostic information than baseline levels, follow-up measurement of troponin I may be warranted for risk stratification. Multimarker risk approach may have enhanced prognostic performance over using either marker in isolation.