Abstract: AIM: To investigate the prognostic significance of terminal QRS distortion (TQRSD) and the relationship between TQRSD and brain natriuretic peptide (BNP) in acute myocardial infarction (AMI). METHODS: The study population consisted of 100 consecutive patients with AMI and was carried out between January 2005 and November 2006. The initial electrocardiogram of the 100 cases with AMI was divided into two groups according to the status of terminal QRS distortion: TQRSD(+) or TQRSD(-). Plasma BNP levels of the 100 cases with AMI were measured by immunoassay at (27±11) h after symptom onset. The incidence of major cardiac events(MACE) and mortality was assessed during a period of 6 months. RESULTS: TQRSD(+) group had higher concentration of plasma BNP (P<0.01). Multiple logistic regression analysis showed that BNP was independently associated with 30-day, 3-month and 6-month incidence of MACE and 30 day mortality. TQRSD was independently associated with 30 day, 3-month and 6-month incidence of MACE. However, TQRSD lost its predictive value after BNP was introduced into the model. CONCLUSION: Patients with TQRSD(+) have higher concentrations of plasma BNP. BNP is independently associated with short-term incidence of MACE and mortality. TQRSD is independently associated with short-term incidence of MACE.