Objective To investigate the influencing factors of long-term mortality in patients with acute myocardial infarction (AMI). Methods The data of AMI patients hospitalized in Department of Cardiovasology of The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan.2007 to Dec.2018 were collected.The patients who survived in the hospital were followed up, and the influencing factors and their predictive value for long-term mortality were analyzed by Cox survival analysis and receiver operating characteristic (ROC) curve. Results A total of 4 868 patients with AMI were included, of which 261 died in hospital and 1 081 were lost to follow-up.A total of 3 526 patients were followed up.Advanced age, diabetes mellitus, smoking, and elevated serum creatinine, lipoprotein(a) and troponin were independent risk factors for long-term mortality in AMI patients.For every 1-year increase in the age of onset, the risk of long-term mortality increased by 7.5% (hazard ratio ［HR］=1.075, 95% confidence interval ［CI］ 1.064-1.086, P＜0.001).The long-term mortality risk of smokers with AMI was 1.261 times that of non-smokers (HR= 1.261, 95% CI 1.023-1.555, P＜0.05).The long-term mortality risk of diabetes patients with AMI was 1.307 times that of non-diabetes patients (HR=1.307, 95% CI 1.073-1.592, P＜0.01).Primary percutaneous coronary intervention (PCI) or elective PCI, use of statins, use of β-blockers, and elevated hematocrit were protective factors for long-term mortality.The risk of long-term mortality in patients treated with primary PCI or elective PCI was reduced by 46.9% and 54.8%, respectively (HR=0.531, 95% CI 0.398-0.707, P＜0.001; HR=0.452, 95% CI 0.353-0.580, P＜0.001), reduced by 39.2% in patients treated with statins (HR=0.608, 95% CI 0.408-0.906, P＜0.05), and reduced by 17.7% in patients treated with β-blockers (HR=0.823, 95% CI 0.678-0.998, P＜0.05).ROC curve analysis results showed that except for age (area under curve ［AUC］=0.773), the predictive value of serum creatinine, lipoprotein(a), hematocrit, and troponin for long-term mortality was relatively low in AMI patients (AUC=0.636, 0.564, 0.667, and 0.524). Conclusion Primary PCI or elective PCI and use of statins or β-blockers can improve the long-term prognosis of patients with AMI, while advanced age, diabetes mellitus, and smoking may increase the risk of long-term mortality.