Accumulating evidence indicates that atherosclerosis is a chronic disease characterized by inflammation and lipid accumulation. Inammation is an important mechanism of atherosclerosis, atherosclerotic plaque progression, or even predisposing vulnerable plaque to rupture. Therefore, inammatory markers are predictors of recurrent events in ACS. Levels of plasma markers of inflammation such as CRP are elevated in acute coronary syndrome. Recent data point to a key role of the Wnt signaling pathway in the regulation of inflammation. The Wnt pathway is regulated by multiple families of secreted antagonists, including soluble frizzled related receptors and dickkopfs ; the best-studied of DKKs is DKK-1. Recent reports showed increased expression of DKK-1 in advanced atherosclerotic plaque, and serum levels of DKK-1 gave prognostic information for patients with multiple myeloma and other malignancies, as well as osteoarthritis. The inammatory process that underlines atherosclerosis is mediated by a multitude of cytokines and is unlikely to be totally reected by CRP level alone. No previous study has evaluated the association of DKK-1 and ACS with the Global Registry of Acute Coronary Events hospital-discharge risk scores predicting major adverse cardiac events, nor an association with MACE at 2-year follow-up. Hence, we sought to gain greater insight into the association of the inflammatory biomarkers DKK-1 and highsensitivity CRP and baseline characteristics of patients with ACS to improve the predictive performance of the validated and well-performing GRACE risk scores. DKK-1, as a major regulator of the Wnt pathway, plays a key role in cardiovascular disease. We investigated the association of DKK-1 in ACS and whether the GRACE hospital-discharge risk score for MACE could be improved by adding the DKK-1 value. We also investigated an association of DKK-1 level and MACE at 2-year follow-up. Plasma DKK-1 level at baseline was higher for patients with than without STEMI and was correlated with hsCRP level. Plasma DKK-1 level was higher with high than intermediate or low GRACE scores and was higher for patients with than without MACE. The AUC for GRACE score predicting MACE was best with both hs-CRP and DKK-1 levels added. Plasma levels of DKK-1 may be useful for identifying and for longterm we adjusted for the acute phase response to reduce its effect on blood glucose levels prediction for patients with ACS at high risk of MACE, especially when combined with hs-CRP for the GRACE score. Numerous epidemiology studies have indicated the role of inflammation in atherosclerotic plaques and an association of circulating inflammatory markers such as CRP or interleukin-6 and severity of cardiac events in ACS. Abnormal Wnt signaling is associated with many human diseases and plays a distinct role in inflammation and immunity. The Wnt pathways are regulated by multiple families of secreted antagonists, including soluble frizzled-related receptors and DKKs, the best-studied being DKK-1. DKK-1 has been implicated in cancer, brain ischemia, and bone disease ; previous studies have shown a close association of serum levels of DKK-1 and atherosclerotic diseases such as premature myocardial infarction or ischemic cerebrovascular disease. The increased expression of DKK-1 in advanced carotid plaques enhancing the inflammatory interaction between platelets and endothelial cells might drive the inflammatory loop, Overexpression of DKK-1 was found in macrophages and endothelial cells, and immunostaining of thrombus material from the site of plaque rupture.