Background: We investigated the diagnostic value of the ratio of high sensitivity troponin to cystatin C in CKD patients with stage ≥ 3 chronic kidney disease (CKD) and acute myocardial infarction. Methods: We retrospectively analyzed 401 patients with suspected acute myocardial infarction (AMI) who underwent coronary angiography in the chest pain center at our hospital during 2013–2019. Among the 196 patients studied, 113 were placed in an AMI group and 83 in a non-AMI group. Results: There were no significant differences in age, sex, or the presence of hypertension, diabetes, gout/hyperuricemia, stroke, tumor, or epidermal growth factor receptors between the two groups (P > 0.05). A correlation analysis showed that there was a positive correlation between CysC and Cr, with a correlation coefficient of 0.872 (P < 0.001). A receiver operating characteristic curve for the high-sensitivity cardiac troponin T (hs-cTnT)/CysC ratio showed an area under the curve value of 0.925 (P < 0.001), with sensitivity of 78.4% and specificity of 94.0%. Conclusion: The hs-TnT/CysC ratio can thus be used as an index to predict AMI in patients with stage≥ 3 CKD.