The American Idol fourth-season champ received Top Female Vocalist honors for the third straight year, defeating Miranda Lambert, Martina McBride, LeAnn Rimes and Taylor Swift.
"Wow. God is good. God is good," said Underwood during her acceptance speech. "I'd like to thank the most wonderful family in the world -- I have great parents, great sisters, great family. Thank you to everybody at Arista Nashville... Everybody that's worked so hard. Everybody at 19 Management... There's so many people that have done so many wonderful things for me. I know I don't deserve it, but I'll take it. Thank you fans! Fans got me everything that I have and I owe everything to you."
Lambert didn't go home empty handed however, as the original Nashville Star third-place finisher's second album "Crazy Ex-Girlfriend" -- which was released last May and peaked at No. 1 on Billboard's country album chart -- took home Album of the Year honors.
"I don't know what to say. I was not expecting this at all," said Lambert during her acceptance speech. "I was sitting right behind [fellow nominee] Kenny Chesney and I just don't feel right taking this. But thank you so much to my fans and the industry for accepting me so much -- being a little left of center. I'm a songwriter. I poured my heart and soul into this alum. It's a part of who I am. Thank you for appreciating it."
In addition to receiving a nomination for Album of the Year -- a category that Underwood claimed last year with her debut album "Some Hearts" -- Lambert had also received a nomination in the Single of the Year category for "Famous in a Small Town." However that award went to Sugarland's "Stay."
Idol fifth-season finalist Kellie Pickler was also nominated for Top New Female Vocalist, however that award that was won by Swift, the teenage singer that's become close friends with Pickler. Lambert won it last year, and Underwood took home the award in 2006.
"Kellie, I love you!" were Swift's first words during her acceptance speech.
Original Idol winner Kelly Clarkson had also received a nod for her "Because of You" duet with Reba McIntyre in the Vocal Event of the Year category, which was won by "Find Out Who Your Friends Are" by Tracy Lawrence, Tim McGraw and Kenny Chesney.
Underwood, Lambert, Pickler and former Nashville Star host LeAnn Rimes all performed at the live awards ceremony, which was held at Las Vegas' MGM Grand Garden Arena.