Objectives The aim of this study was to evaluate the role of β-type natriuretic peptide (BNP), in prediction of ventricular arrythmia within 90 days after the onset of an acute myocardial infarction (MI) in patients who developed left ventricular systolic dysfunction during such period. Background Despite all the advances in therapeutic pharmacological measures and in spite of proven effectiveness of implantable cardioverter defibrillators in prevention and management of ventricular tachycardia, it is still a great problem and a major cause of mortality in this group of patients, so better identification of patients who could benefit from an cardioverter defibrillator and those who are unlikely to benefit would definitely improve the outcome in these patients. Moreover, proper selection would help high-risk patients get benefit from these interventions. Patients and methods We measured BNP in 60 consecutive patients after ST-elevation myocardial infarction and who developed left ventricular systolic dysfunction (ejection fraction<50%) (45 males, represent 75%, with mean age of 57.6±8.5 years old),3–5 days only after onset of MI. Results Mean age in our patients was 57.6±8.5 years (range: 35–80 years). Men constituted 73.4% (44 men) of our studied patients. We found mean NYHA of 2.9, mean Killip class of 2.8, and mean TIMI risk score of 8.2. Follow-up was done within 90 days. The number of patients who survived was 48 (80%), and ventricular arrhythmias was documented in seven (11.8%) cases. BNP proved to be a useful marker in predicting ventricular tachycardia by plotting the receiver operating characteristic curve that revealed area under the curve of 69.6%. Conclusion BNP levels are a strong, independent predictor of sudden death in patients with ischemic cardiomyopathy after an acute MI.