Introduction: The goal of the current study was to evaluate the prognostic value of the potential cardiorenal biomarkers kidney injury molecule-1 (u-KIM-1), N-acteyl-ß-D-glucosaminidase (NAG) and urinary neutrophil gelatinase-associated lipocalin (u-NGAL) regarding mortality and major adverse cardiac events (MACEs) in patients presenting with acute chest pain in the emergency department. Methods: The study cohort consisted of 294 patients who presented themselves with acute chest pain in the emergency department of the university hospital Regensburg. The urinary concentrations of NAG, KIM-1, and NGAL were measured alongside troponin I and NT-proBNP. The patients were followed for 60 months regarding the primary endpoints mortality of any cause and MACEs, consisting of mortality, stroke, congestive heart failure and acute coronary syndrome with the necessity of PCI was gathered (MACE). Results: Fifty four patients died during the follow-up and 97 suffered from MACE. Regarding ROC-analysis NAG as well as u-KIM-1 showed promising predictive values (all-cause mortality: AUCNAG 0.821, AUCKIM-1 0.745, MACE: AUCNAG 0.778, AUCKIM-1 0.692). u-NGAL showed less promising AUCs regarding mortality (AUC 0.69) as well as MACE (AUC 0.66). According to the Kaplan-Meier analysis, patients with concentrations of urinary N-acetyl-β-D-glucosaminidase, u-KIM-1 or u-NGAL > median showed a significant worse outcome regarding MACE as well as all-cause mortality (each p < 0.05). Furthermore, Cox-regression analysis revealed NAG as independent predictor beside NT-proBNP and older age for mortality due to any cause and MACE (each p < 0.001), opposite to u-KIM-1, hypertension and diabetes (each p = n.s.). Conclusion: Urinary N-acetyl-ß-D-glucosaminidase and, to a lesser extent, kidney injury molecule-1 showed significant value in prediction MACEs and mortality due to any cause in patients with acute chest pain. But the clinical usability is still not certain and further studies are required.