Objective Recent studies suggest that the red blood cell distribution width ( RDW) may play a role in the diag-nosis and treatment of cardiovascular disease.The aim of this study was to investigate the correlation of red blood cell distribution width (RDW) with cardiovascular events in patients with Acute ST-segment elevation myocardial infarction (ASTEMI) in order to provide the basis for improving the diagnosis level and therapeutic effect. Methods Retrospective study was made on the clinical data of 189 patients with ASTEMI enrolled in Sichuan Provincial People′s Hospital from January 2013 to March 2014.The survival rates of patients with ASTEMI with different RDW were estimated by Kaplan-Meier and compared by Log-rank test and the prognosis factors were inves-tigated by Cox proportional hazard regression model. Results 97 patients′RDW levels were more than 13.7% and 92 patients′RDW levels were less than or equal to 13.7% in 189 ASTEMI patients. The hs-CRP, BNP, LVEF and HDL-C were significantly different be-tween two groups (P<0.05).The rates of recurrent myocardial in-farction, heart failure, sudden death cardiac in patients with highRDW were higher than that in patients with low RDW (22.7%vs 8.7%, 27.8%vs 10.9%, 15.5%vs 5.4%)(χ2 =6.915, 8.632, 5.019, P<0.05) .There were 60 patients with high RDW who experienced cardiovascular events and the 1-year cardiovascular event-free survival rate was 38.1%, and 20 patients with low RDW cardiovascular events was 79.3% in follow-up period (χ2 =30.959, P<0.001).Multivariate cox regression showed that age>65 (HR=2.43, 95%CI:1.09~5.44) and RDW>13.7%(HR=2.20, 95% CI:1.10~4.43) were risk prognostic factors. Conclusion There is a certain correlation between RDW and cardiovascular e-vents in patients with ASTEMI.The ASTEMI patients with high RDW hold higher risk of cardiovascular events and poorer prognosis.