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Introduction: Contrast-induced acute kidney injury (CI-AKI) after percutaneous coronary intervention (PCI) is associated with adverse short- and long-term cardiovascular outcomes in patients with acute coronary syndrome (ACS). However, the association between the reduction in glomerular filtration rate (GFR) at baseline, CI-AKI, and their prognostic significance on cardiovascular outcomes has not been established. Hypothesis: We hypothesized that the decreased GFR on admission would be associated with cardiovascular outcomes in patients with ACS independent of CI-AKI. Methods: This study consists of consecutive 283 ACS patients (67±12 years old, 207 men) underwent primary-PCI. Decreased admission GFR was defined as less than 60 ml/min per 1.73m2. CI-AKI was defined as an increase of serum creatinine more than 25% within 72 hours after PCI. The primary endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular death and non-fatal myocardial infarction. Results: Of the 283 ACS patients, 59 (21%) had CI-AKI. During median follow-up of 2-year, MACE was occurred in 36 (12%, 5.3% per year) patients. Multivariate Cox proportional hazard analysis demonstrated that higher age (hazard ratio [HR], 1.06, 95% confidence interval [CI], 1.02-1.11; p=0.002), decreased admission GFR (HR, 3.3, 95% CI; 1.45-8.02; p=0.004), and CI-AKI (HR, 2.5, CI, 1.10-5.65; p=0.03) were associated with MACE. Kaplan-Meier analysis demonstrated that patients with decreased admission GFR and CI-AKI presented worse outcomes compared with those without decreased admission GFR and CI-AKI (P Conclusions: Decreased admission GFR and CI-AKI were independent robust predictors of future MACE in ACS patients underwent primary-PCI.