AbstractBackground: Sudden Cardiac Death (SCD) is still a challenge despite advances in diagnostic and therapeutic and inspite of effectiveness of Implantable Cardioverter Defibril-lators (ICDs), a better identification of patients with depressed ventricular function who could benefit from an ICD or, perhaps more importantly, those who are unlikely to benefit would helpin their management.Aim of Study: Was To assess the prognostic value of B-type Natriuretic Peptide (BNP), in predicting sudden cardiac death within 90 days from the onset of MI in pts who developed LV dysfunction in this period.Methods: We measured NT pro BNP in 60 consecutive post-STEMI patients with LV systolic dysfunction (<EF 50%), (45 men, represents 75% with mean age 57.6±8.4 years old), 3 to 5 days after onset chest pain.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%), of whom life-threatening arrhythmias was documented in seven patients (11.7%), 12 pts had SCD (20%). Pro-BNP as evidenced as a useful marker in predicting SCD by plotting the ROC curve that revealed AUC for 0.775 for prediction of sudden cardiac death, while AUC was 69.6% of ROC curve of same neuropeptide in evaluating accuracy in prediction VT, by. Kaplan Meier analysis shows that rise of pro-BNP above 3.2ng/ml has a significant predictive impact upon SCD, [OR 0.748 (CI 95%: 0.07-0.932), p-value .039].Conclusion: BNP levels are a strong, independent predictor of sudden death in patients with ischemic cardiomyopathy after an acute MI.