Acute myeloid leukemia (AML) with 3q26 rearrangements has a poor prognosis and typically causes ecotropic viral integration site1 (EVI1) overexpression (EVI1oe), however, many AML patients with EVI1oe have undetected 3q26 rearrangements. This study aimed to re-stratify AML patients with EVI1oe. We retrospectively reviewed diagnostic outcomes of 1,327 patients tested at our institute from November 2015 to December 2022. A total of 468 de novo AML patients were included, with 191 classified as EVI1oe. 18 AML patients with EVI1oe had detectable 3q26 rearrangements, showing significantly higher EVI1 expression levels compared to those without rearrangements. A new cutoff value for EVI1oe in AML patients, determined as 122% using the ROC curve based on overall survival (OS), effectively distinguishes the prognosis of EVI1oe AML patients without detectable 3q26 rearrangements (p=0.0051 and 0.0039, respectively). Using this cutoff value, along with ELN stratification, transplantation status, response to induction therapy, and bone marrow blast percentage, we constructed a nomogram model (C-index=0.808). This model stratified patients into two risk subgroups, with the low-risk group showing better OS than the high-risk group (p