Abstract: AIM: To evaluate the long-term prognostic value of high-sensitivity C-reactive protein and its combination with serum cholesterol in patients with acute coronary syndrome (ACS). METHODS: A total of 246 consecutive patients diagnosed with ACS were included. Their hs-CRP concentration and cardiac troponin T (cTnT) on admission and baseline levels of lipids profile were determined. The major adverse cardiovascular events (MACE) including cardiac death, recurrent nonfatal myocardial infarction and readmission for severe angina in the hospital and during the follow-up period were registered and accordingly, patients were divided into study group (n=121) and control group (n=120). Clinical features of the two groups were compared. Risk stratifications were made based on the different levels of independent predictors for MACE. RESULTS: There were 241 subjects who completed the whole study. One hundred twenty-one cases presented with MACE, including 47 cases of cardiac death. The disparity of age and baseline levels of white blood cell (WBC) counts, hs-CRP, LDL-C/HDL-C and cTnT were statistically significant between groups (P<0.05). Hs-CRP and LDL-C/HDL-C were independent predictors of MACE when adjusted by age and baseline levels of WBC counts and cTnT. The risk of MACE increased with the increment of hs-CRP and LDL-C/HDL-C, respectively (both P<0.05). As for patients in the lowest tertile of LDL-C/HDL-C, higher hs-CRP levels indicated higher risk. Patients with hs-CRP and LDL-C/HDL-C both in the highest tertile had the highest events rates (74.2%). CONCLUSION: Hs-CRP has independent prognostic value for the long-term outcome of recurrent cardiovascular events in ACS and shows incremental prediction in combination with blood cholesterol.