Abstract: Objective To explore the relation between serum total bilirubin(STB) and serum direct bilirubin(SDB) levels and in-hospital mortality of patients with acute ST-segment-elevation myocardial infarction(STEMI) who undergo primary percutaneous coronary intervention(PCI). Methods A total of 427 acute STEMI patients in Nanjing Drum Tower hospital were enrolled in the study and their clinical data were collected and analyzed.SPSS 20.0 software was used to compare the differences between two groups,the receiver operating characteristic curve analysis and a Cox proportional hazards regression model was used to determine the relationships between the bilirubin and the in-hospital mortality. Results Elevated STB level(STB ≥ 19.85 μmol/L)and SDB level(SDB ≥ 4.65 μmol/L) were associated with a high risk of death(HR=2.38,95%CI:1.05-5.40;HR=3.91,95%CI:1.66-9.17,respectively).After adjusting for other confounders(gender,history of smoking,drinking,diabetes,stroke,locations of MI),evaluated STB level and SDB were still independently associated with a higher risk of death(HR=2.71,95%CI:1.19-6.16;HR=4.49,95%CI:1.90-10.59,respectively). Conclusion Higher STB and SDB levels after PCI may increase the in-hospital mortality of STEMI patients.