Background: There are conflicting reports on the role of baseline low-density lipoprotein cholesterol (LDL-C) as an adverse prognostic predictor in patients with acute heart failure (HF) after acute myocardial infarction (AMI). Methods: Between November 2005 and January 2008, 2,172 statin-naive patients who had acute HF of Killip class II-IV or left ventricular dysfunction with an ejection fraction of less than 40% were selected from the Korea AMI registry. The 6-month major adverse cardiovascular events (MACE) were defined as a composite of death, non-fatal MI, and revascularizations. Patients were categorized into 10 groups according to the baseline LDL-C levels. Results: Overall, the 6-month MACE was 13.2%. The 6-month MACE showed ���J��� shaped curve (figure) with higher event rates in very low (19.0%; <67 mg/dL) and very high LDL-C levels (12.8%; >166 mg/dL) and lowest rate at LDL-C of 121-131 mg/dL (8.3%) (p for trend <0.001). In Cox proportional hazard model, the 6-month MACE was significantly higher in patients with baseline LDL-C level of less than 110mg/dL after adjustment for confounding variables. In these group (LDL-C <110mg/dL), the 6-month MACE was significantly lower in statin patients compared with no-statin patients (13.1% versus 21.6%; crude hazard ratio [HR] 0.571, 95% confidence interval [CI] 0.424–0.768; p<0.001). Propensity scores for statin use were calculated for each of the patients, and were used to match 342 patients not receiving statin with 342 patients receiving statin. In Cox proportional-hazards model, there were no significant differences in the rate of 6-month MACE between statin and no-statin patients (14.9% versus 17.5%; HR 0.828, 95%CI 0.570–1.203; p=0.322). Conclusions: Although low baseline LDL-C levels appear to predict less favorable outcomes, there was no significant benefit of statin therapy for reducing 6-month MACE in these patients with HF after AMI.