BACKGROUND: Survival in patients with infective endocarditis (IE) ranges from 4 to 50% as reported. However, independent predictors of long-term mortality have not been well described. The aim of this study was to report the experience with IE over the past 5 years in a single tertiary center, and determine the clinical predictors of long-term mortality. METHODS: We conducted a retrospective analysis of data in patients with IE registry at our center from 2000 to 2004. Demographics, clinical characteristics, and outcome were reviewed in the subgroup of patients with first-episode IE met by definite modified Duke's criteria excluding possible diagnosis and recurred cases. RESULTS: A total of 45 patients were retrospectively reviewed. Mean follow-up was 1.5 years (range, 0.1- 5 years). Mean age was 48짹18 years with 22(44.4%) females. Aortic valvular diseases(n=25, 55.6%) were the most frequent underlying conditions with aortic regurgitation the most common(n=23, 51.1%). Thirty two(71.1%) patients were undergone open heart surgery. One-year mortality including in-hospital death, cerebral complications, and heart failure was 15.6% and 5-year survival rate was 66.8%. A poor 5-year outcome was associated with clinical features of long duration of preceding symptoms before admission, longer hospital stay, low hemoglobin, and low serum albumin on admission. In the multivariate regression analysis, the only independent predictor of 5-year mortality was low serum albumin(p=0.03). CONCLUSION: In this retrospective survey from a tertiary center, low serum albumin level on admission was an only independent predictor of 5-year mortality in patients with first infective endocarditis.