Abstract Background In ST-elevation myocardial infarction (STEMI) B-type natriuretic peptide (BNP) holds promise for risk stratification. Aim of this study was to assess prognostic value of plasma BNP measurement and to compare with other powerful prognostic markers — TIMI Risk Score (TRS) and C-reactive protein (CRP) in patients with first STEMI treated with primary PCI (pPCI). Methods 86 patients, admitted within initial 12 h of the first STEMI. Admission plasma levels of BNP were measured by MEIA method. Serum levels of CRP were measured using immunoturbidimetric assays. Composite end point (CEP) was assessed after 7 months. Results Median plasma BNP value was higher in patients with CEP, compared with those without CEP ( p < 0.001). Patients with plasma BNP > 99.2 pg/mL were at significantly higher risk for CEP (the highest sensitivity and specificity). CRP level > 10.6 mg/dL was also associated with poor outcome. TRS has not influenced the occurrence of CEP. In the analysis of logistic regression the BNP value > 99.2 pg/mL was the strongest predictor of CEP. ROC analysis identified BNP measurement as significant to estimate adverse outcome 0.950 in the prediction of CEP (95% Confidence interval = 0.878–0.985). Conclusion Admission plasma BNP concentrations provide incremental prognostic information in patients with first STEMI treated with pPCI.