Backgrounds: Heart failure is significantly prevalent in renal dysfunction and growing evidences from recent studies indicate the combined impact of anemia with dysfunction of those two vital organs is highly detrimental to overall prognosis of patients. In acute myocardial infarction (AMI) with decompensated heart failure, various pathologic conditions influence the clinical course of the disease. The aim of the present study is to evaluate the impact of cardiorenal anemia syndrome (CRAS) on long term clinical outcome in the setting of AMI with acute decompensated heart failure(ADHF). Methods: From January 2004 to December 2009, 5694 patients who received percutaneous coronary intervention (PCI) with drug eluting stent in Convergent Registry of cAtholic and chonnAm university of AMI(COREA-AMI) were analyzed. Patients were stratified into two groups; those with AMI without ADHF. And those with AMI combined with ADHF. Cardiorenal anemia syndrome was defined as combination of LVEF ��� 50%, eGFR ��� 60 ml/min/1.73 m2 and anemia ���12 g/dl in men and ���11 g/dl in women. Cox regression analysis was performed to assess the effect of variables in terms of long term clinical outcome. Primary end point was composite of all cause death, nonfatal MI,stroke,TLR and TVR Results: Baseline characteristics analysis showed that ADHF group was more aged (p<0.001), contained more females (p<0.001), diabetes (p<0.001), hypertension (p<0.001). ADHF group was significantly more anemic (13.42짹8.23 vs 14.01짹8.77, p =0.026) and lower in eGFR (70.70짹41.93 vs 94.9짹61.39). CRAS more frequent in ADHF ( 8.8 vs 2.1 %, p<0.001 ) Cox regression analysis showed that history of cardiovascular accident,high sensitive C-reactive protein and CRAS ( HR 2.783,95% CI:1.717-4.509, p<0.001) was significantly associated with composite of all cause death, nonfatal MI, stroke, TLR, TVR. Conclusion: CRAS has significant impact on long term clinical outcome in patients with AMI and ADHF