<b><i>Introduction and Objective:</i></b> Neutrophil gelatinase-associated lipocalin (NGAL), a glycoprotein released by renal tubular cells, can be used as a marker of early tubular damage. We evaluated plasma NGAL level utilization for the identification of acute kidney injury (AKI) among ST-elevation myocardial infarction (STEMI) patients undergoing primary coronary intervention (PCI). <b><i>Methods:</i></b> 131 STEMI patients treated with PCI were prospectively included. Plasma NGAL levels were drawn prior to PCI (0 h) and 24 h afterwards. AKI was defined per KDIGO criteria of serum creatinine increase. Receiver-operating characteristic (ROC) methods were used to identify optimal sensitivity and specificity for the observed NGAL range. <b><i>Results:</i></b> Overall AKI incidence was 14%. NGAL levels were significantly higher for patients with AKI at both 0 h (164 ± 42 vs. 95 ± 30; <i>p</i> &#x3c; 0.001) and 24 h (142 ± 41 vs. 93 ± 36; <i>p</i> &#x3c; 0.001). Per ROC curve analysis, an optimal cutoff value of NGAL (&#x3e;120 ng/mL) predicted AKI with 80% sensitivity and specificity (AUC 0.881, 95%, CI 0.801–0.961, <i>p</i> &#x3c; 0.001). In a multivariate logistic regression model, NGAL levels were independently associated with AKI at 0 h (OR 1.044, 95% CI 1.013–1.076; <i>p</i> = 0.005) and 24 h (OR 1.018, 95% CI 1.001–1.036; <i>p</i> = 0.04). <b><i>Conclusions:</i></b> Elevated NGAL levels, suggesting renal tubular damage, are independently associated with AKI in STEMI patients undergoing primary PCI.