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High serum triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio has been reported as an independent predictor for cardiovascular events in the general population. However, the prognostic effect of the TG/HDL-C ratio on patients with kidney dysfunction is unclear. We examined the association of TG/HDL-C ratio and major adverse cardiovascular events (MACEs) in patients with acute myocardial infarction (AMI) according to kidney function.This study was based on a retrospective cohort, the Korean Acute Myocardial Infarction Registry (KAMIR) database. Among 13,897 patients who diagnosed AMI from November 2005 to July 2008, we studied 8,225 patients who had baseline TG/HDL-C ratio. Patients were categorized into three groups by estimated glomerular filtration (eGFR) and the TG/HDL-C ratio was categorized into tertiles based on the quantity of the study population and the distribution of TG/HDL-C ratio. The primary end point was 12-month MACEs including cardiac death, MI, and repeated PCI or coronary artery bypass grafting.During 12-month follow up period, 686 patients (8.3%) had MACEs. The log-rank test identified a significant association between the TG/HDL-C ratio and MACEs (p < 0.001) in the whole study cohort. In patients with normal kidney function (eGFR > 60 ml/min per 1.73 m2) and mildly reduced kidney function (eGFR = 60–89 ml/min per 1.73 m2), higher TG/HDL-C ratio was associated with increased risk of MACEs (hazard ratio [HR] 1.65, 95% confidence interval [CI] 1.01–2.69, p = 0.018; HR 1.46, 95% CI 1.06–1.99, p = 0.02, respectively). However, in patients with moderately reduced kidney function (eGFR < 60 ml/min per 1.73 m2), higher TG/HDL-C ratio did not associated with increased risk of MACEs (HR 1.42, 95% CI 0.93–2.17, p = 0.104).A higher serum TG/HDL-C ratio is associated with increased risk of MACEs in patients with normal and mildly reduced kidney function. However, in patients with moderately reduced kidney function, the TG/HDL-C ratio did not revealed significant association with MACEs.