Background: Aluminum phosphide (ALP) is a major cause of suicidal poisoning in Egypt, with a high mortality rate owing to cardiac toxicity. Aim of the work: To explore the value of PGI score [stands for blood pH, Glasgow Coma Scale (GCS), and Impaired systolic blood pressure (SBP)] as a predictor of cardiotoxicity and mortality in acute ALP-poisoned patients. Methods: A prospective study was conducted on acute ALP-poisoned patients presented to Zagazig University Hospital from October 2021 to March 2022. Patients who met the inclusion criteria were assessed at presentation by PGI score. Electrocardiogram (ECG) was done immediately and repeated as needed. On admission, serum troponin T and creatine phosphokinase-MB (CPK-MB) levels were measured. According to the outcome, patients were categorized into survivors and non-survivors. Results: 73 patients were classified based on the PGI score as follow; 4 patients had score 0, 6 patients had score 1, 27 patients had score 2, and 36 patients had score 3. PGI score 3-patients displayed the highest mortality incidence contrary to those with score 0 (100% VS 25%). All PGI 3-patients ingested one tablet or more of ALP, exhibited ECG changes, and required vasopressors and mechanical ventilation, unlike to score 0 and 1-patients. Troponin T levels significantly elevated in the non-survivors, while CPK-MB levels showed no significant difference among the two groups. The PGI score negatively correlated with the survivability, while positively correlated with ALP ingested amount, ECG changes, serum troponin T levels, vasopressors need, and ventilation requirement. In ALP-poisoned patients, the best cutoff point of PGI score for cardiotoxicity prediction was ≥1, with 93.9% sensitivity and 85.7% specificity. Meanwhile, the best cutoff point of PGI score for mortality prediction was ≥2, with 95.4% sensitivity and 87.5% specificity. Conclusion: The PGI score is a recommended predictor of cardiotoxicity and mortality in ALP-poisoned patients