Abstract: Objective Acute myocardial infarction (AMI) is a serious disease with high mortality rate, and the detection of risk factors will contribute to the prognosis of patients with AMI. The aim of this study is to determine the serum levels of prealbumin (PA) in patients with AMI and investigate the relationship between the levels of PA and the prognosis of patients with AMI. Methods Total 140 cases of AMI patients, from January, 2014 to December, 2016 in our hospital inpatients, according to the hospital survival or death, were divided into survival group (AS, n=90) and death group(AD, n=50 AMI) and another 60 cases with negative underwent coronary angiography as normal control group(NC). The difference analysis among the three groups were compared the level of PA using ANOVA, and t test was used between the two groups. The factors that may affect the Pearson test to explore PA, Logistic regression analysis of independent risk factors of death of AMI patients. Results PA in group AD was significantly lower than that of NC group and AS group(respectively, P<0.05); PA was related with blood cholesterol esters(r=-2.353, P=0.022), triglycerides(r=1.572, P=0.001), low density lipoprotein(r=3.959, P<0.001) and apolipoprotein A1(r=5.446, P<0.001). Logistic regression analysis showed that PA and age were independent risk factors of death in patients with AMI. Conclusion The decrease of serum PA level is one of the early prognostic factors in patients with AMI, and is an independent risk factor of death in AMI patients.