Prognostic Value of Adrenomedullin in Patients With left ventricular systolic dysfunction after an Acute Myocardial Infarction. Objectives: This study sought to assess the prognostic impact of adrenomedullin ADM after an acute myocardial infarction (AMI). Background: Adrenomedullin (ADM) is elevated in heart failure (HF) and after AMI and compared it with N-terminal pro-B-type natriuretic peptide (NTproBNP), a marker of death and HF. Methods : We measured plasma ADM and NTproBNP in 60 consecutive post-ST elevated AMI patients with systolic dysfunction (< EF 50%), (45 men, represents 75% with mean age57.6±8.4 years old ), 3 to 5 days after chest pain onset. Results: Mean age of studied patients was 57.6±8.4 years old (Range 35-80). Males constituted 73.3% of our study population (44 males), we found mean NYHA 2.8 , mean Killip class of 2.9 and mean TIMI risk score of 8.3. Follow-up was done at 90 days. Forty eight patients survived (80%). Two patients’ experienced cerebrovascular events (3.3%), two patients experienced re-infarction (3.3%), and seven patients experienced life-threatening arrhythmias (11.7%). ADM had proved to have a significant prognostic value in predicting mortality if compared to Pro-BNP as evidenced by plotting the ROC curve that revealed AUC for ADM to be 0.977 and 0.775 for Pro-BNP. The same significant higher prognostic power for ADM applies for predicting MACE using ROC curve and estimating AUC. Multivariate analysis showed that ADM was the only predictor for MACE. ADM: (OR 1.62, CI 95%: 1.19-2.20, P value .002).Conclusion: the ADM system is activated after AMI. The ADM may represent a clinically useful marker of prognosis in patients with LV dysfunction after an acute AMI.