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Introduction and objectives: The aim of this study was to investigate the association of serum albumin (SA) level with long‐term prognosis in patients with acute pulmonary embolism (PE). Materials and methods: We retrospectively enrolled 269 patients with acute PE. The SA level was obtained within 12‐24 hours following admission. The primary endpoints were the incidence of short‐ and long‐term mortality in acute PE patients. The mean duration of the study follow‐up was 21 ± 19 months. Results: During the follow‐up period, short‐ and long‐term mortality rates were higher in patients who had low SA level compared to those who did not have. In multivariate Cox regression analysis, the SA level was found to be independently associated with long‐term mortality (HR: 0.47, 95%CI: 0.28‐0.78, P = 0.004). In receiver operating characteristics analysis, the SA level of ≤3.17 predicted long‐term mortality with a sensitivity of 77.5% and a specificity of 79.5% (area under the curve 0.82, 95%CI: 0.76‐0.87, P < 0.001). In addition, when the SA plus simplified pulmonary embolism severity index (sPESI) risk score compared to the sPESI risk score alone, it produced a net reclassification improvement of 0.22 with P < 0.001, that is a 22% improved classification. Conclusion: To the best of our knowledge, this is the first study to demonstrate that the low SA level is a strong and independent predictor for long‐term mortality in patients with acute PE. [ABSTRACT FROM AUTHOR]