Background Patients with atherosclerotic renal artery stenosis (ARAS) are in substantial risk of cardiovascular adverse events. We investigated whether myocardial infarction patients with ARAS are in additional risk of cardiovascular events. Methods In this retrospective study, 257 patients with type 1 myocardial infarction were enrolled. Median follow-up was 42 months. Composite endpoint events are analyzed by definitions of ARAS as >= 50% or >= 70% diameter stenosis. Results Defining ARAS as >= 70% diameter stenosis, ARAS was a significant predictor for composite endpoint events including death, non-fatal myocardial infarction, ischaemic stroke and intracranial haemorrhage, rehospitalisation for cardiac failure (HR: 4.381; 95% CI: 1.770-10.842) by Cox regression analysis, but not for death. Diabetes mellitus was also a significant predictor for composite endpoint events (HR: 2.756; 95% CI: 1.295-5.863). However, defining ARAS >= 50% diameter stenosis, ARAS was no longer a significant predictor for composite endpoint events or death. Conclusions Although not associated with mortality, ARAS >= 70% is associated with major adverse cardiac events after acute myocardial infarction. For prognosis, >= 70% diameter stenosis is a more appropriate criteria for ARAS definition than >= 50% diameter stenosis.