<p><b>Context:</b> The endothelin system (Big-ET-1) is a key regulator in cardiovascular (CV) disease and congestive heart failure (CHF).</p> <p><b>Objectives:</b> We have examined the incremental value of Big-ET-1 in predicting total and CV mortality next to the well-established CV risk marker N-Terminal Pro-B-Type Natriuretic Peptide (NT-proBNP).</p> <p><b>Methods:</b> Big-ET-1 and NT-proBNP were determined in 2829 participants referred for coronary angiography (follow-up 9.9 years).</p> <p><b>Results:</b> Big-ET-1 is an independent predictor of total, CV mortality and death due to CHF.</p> <p><b>Discussion:</b> The conjunct use of Big-ET-1 and NT-proBNP improves the risk stratification of patients with intermediate to high risk of CV death and CHF.</p> <p><b>Conclusions:</b> Big-ET-1improves risk stratification in patients referred for coronary angiography.</p