Background: In patients with acute myocardial infarction (AMI), N- terminal pro–brain natriuretic peptide (NT-pro-BNP) predicted the prognosis. NT-pro-BNP is high in patients with low glomerular filtration rate. Prognostic value of NT-pro-BNP in azotemic patients with AMI is unknown. Methods: A total of 5367 patients with AMI, in whom NT-pro-BNP was measured with same reagents (Roche Diagnostics, Grenzach-Wyhlen, Germany) were selected from a nationwide Korea Acute Myocardial Infarction Registry (KAMIR). Glomerular filtration rate was estimated (eGFR) using the abbreviated Modification of Diet in Renal Disease Study equation. Patients were divided into 2 groups according to MDRD value; Group 1= eGFR ���60 ml/min/1.73 m2 (n=4,019) vs. Group 2= eGFR < 60 ml/min/1.73 m2 (n=1,348). Primary end points were major adverse cardiac events (MACE) such as cardiac death, myocardial infarction, coronary artery bypass graft (CABG), re-percutaneous coronary intervention (re-PCI). Patients were followed up for 6 months. Results: During a follow-up of 6 months, 362 patients (6.7%) experienced MACEs. NT-pro-BNP was inversely associated with left ventricular ejection fraction (EF) (R = - 0.360, p < 0.001) and eGFR (R= - 0.416, p < 0.001). In univariate analysis, log-transformed NT-pro-BNP (log-proBNP), eGFR, age, body mass index (BMI), EF, previous ischemic heart disease, previous diabetes, Killip class and female gender were significantly associated with the occurrence of the MACEs. In multivariate Cox analysis, independent prognostic predictors were log-proBNP (hazard ratio [HR] 1.377, p < 0.001), Killip class ��� III (HR 1.377, p < 0.001) and age (HR 1.012, p = 0.020). In receiver-operator characteristic (ROC) analysis of Group 1, NT-pro-BNP > 1023.5 pg/ml separated patients with or without MACEs (sensitivity 47.5%, specificity 72.0%). In ROC analysis of Group 2, NT-pro-BNP > 2763.5 pg/ml separated patients with or without MACEs (sensitivity 71.0%, specificity 57.8%). The area under the ROC curve for NT-pro-BNP was 0.622(95% confidence interval [CI] 0.591-0.652; p<0.001) in Group 1 and 0.671(95% CI 0.635-0.707; p<0.001) in Group 2, respectively. Conclusion: NT-pro-BNP predicted short-term progonis of the patients with AMI, with a better prognostic value in azotemic patients.