Background: The goal of this study was to define the clinical characteristics and outcomes of acute myocardial infarction (AMI) based on plasma albumin and bilirubin level. Methods: Between January 2006 to December 2007, 535 consecutive AMI patients (62.9짹12.3 years) were enrolled. They were divided into four groups [group I: <4.0 mg/dL of plasma albumin and <0.6 mg/dL of plasma bilirubin, group II: <4.0 mg/dL of albumin and >0.6 mg/dL of bilirubin, group III: >4.0 mg/dL of albumin and <0.6 mg/dL of bilirubin, group IV: >4.0 mg/dL of albumin and >0.6 mg/dL of bilirubin. Results: The baseline clinical characteristics among four groups showed significant difference in Age (67.8짹10.6 vs. 66.5짹11.1 vs. 60.8짹12.5 vs. 60.8짹12.3, p<0.001), BMI (23.3짹2.8 vs. 23.8짹2.8 vs. 24.2짹3.0 vs. 24.2짹3.0, p=0.003) with analysis of variances(ANOVA). In analysis of past history, there were no differences among four groups in hypertension (56.0% vs. 50.0% vs. 45.4% vs. 50.0%, p=0.479), diabetes mellitus (34.7% vs. 32.4% vs. 29.9% vs. 26.4%, p=0.112), smoking (61.3% vs. 54.1% vs. 58.3% vs. 62.7%, p=0.381) and family history (2.7% vs. 5.6% vs. 8.4% vs. 6.7%, p=0.257). In physical findings, the group of low level of albumin and bilirubin showed more higher in Killip classification (25.3% vs. 26.1% vs. 9.3% vs. 9.1%, p<0.001). In laboratory findings, there were significant difference in lipoprotein (a) levels (33.7짹28.2mg/dL vs. 34.5짹39.2mg/dL vs. 23.2짹18.8mg/dL vs. 29.4짹27.4mg/dL, p=0.014), fibrinogen (390.4짹138.3mg/dL vs. 342.4짹120.3mg/dL vs. 315.5짹93.0mg/dL vs. 321.3짹98.1mg/dL, p=0.001), high sensitivity C-reactive protein (3.3짹3.8mg/dL vs. 3.8짹5.2mg/dL vs. 1.7짹3.0mg/dL vs. 1.9짹3.0mg/dL, p<0.001), N-terminal prohormone brain natriuretic peptide(6115.2짹9232.4pg/mL vs. 4222.2짹6880.3pg/mL vs. 1870.1짹4741.4pg/mL vs. 2051.1짹5485.7pg/mL, p<0.001). There are significant differences in left ventricular ejection fraction(LVEF)(51.0짹13.9% vs. 52.6짹13.0% vs. 57.0짹11.2% vs. 54.9짹13.2%, p=0.009). In coronary angiography finding, we could see significant difference in number of stenotic vessels (1.8짹1.0 vs. 1.5짹0.9 vs. 1.4짹0.7 vs. 1.6짹0.8, p=0.041). In complication, there were significant difference in complication incidence (30.7% vs. 24.3% vs. 10.2% vs 13.3%, p<0.001), ventricular tachycardia (9.3% vs. 7.2% vs. 2.8% vs. 3.7%, p=0.032), cardiogenic shock (14.7% vs. 16.2% vs. 4.6% vs. 7.9%, p=0.013). During follow-up, there were especially significant difference in MACE at 1 month (11.6% vs. 5.8% vs. 1.9% vs. 3.2%, p=0.006). Conclusion: This study suggests that baseline characteristics and outcomes were poor in AMI patients with low levels of serum albumin and bilirubin compared with patients with normal levels.