Background: The aim of the present study was to explore the association of 3 coronary scores with major adverse cardiovascular events (MACE) in patients with acute coronary syndrome (ACS). Methods and Results: The 958 consecutive patients with ACS were followed up until either MACE or 31^st December 2008 occurred; 257 patients reached clinical endpoints. Cox regression analysis demonstrated that the Gensini score was associated with 90-day MACE (relative risk (RR) 1.021, P=0.004), 6-month MACE (RR 1.021, P<0.001), 1-year MACE (RR 1.017, P=0.002), and MACE during follow-up (RR 1.010, P=0.040). Leaman score was associated with 90-day MACE (RR 1.094, P=0.014), 6-month MACE (RR 1.098, P=0.002), and 1-year MACE (RR 1.074, P=0.009). The logistic regression analysis demonstrated that the Gensini score (odds ratio (OR) 1.037, P=0.001), Leaman score (OR 1.165, P=0.007) and American College of Cardiology/American Heart Association (ACC/AHA) score (OR 1.235, P=0.025) were all associated with cardiogenic death. Conclusions: The Gensini score provides more valuable prognostic information on cardiovascular risk than either the Leaman or ACC/AHA score in patients with ACS. (Circ J 2010; 74: 490 - 495)