CONTEXTFew studies have investigated the relation between alcohol consumption, former drinking, and prognosis after an acute myocardial infarction (AMI), particularly for non-fatal outcomes.OBJECTIVETo investigate the prognostic importance of drinking habits among patients surviving a first AMI.DESIGN, SETTINGS, AND PATIENTSA total of 1346 consecutive patients between 45-70 years with a first non-fatal AMI underwent a standardized clinical examination and were followed for over 8 years.MAIN OUTCOME MEASURESTotal and cardiac mortality and hospitalization for non-fatal cardiovascular disease in relation to individual alcoholic beverage consumption at the time of AMI and 5 years before inclusion, assessed by a standardized questionnaire administered during hospitalization.RESULTSWe recorded 267 deaths, and 145 deaths from cardiac causes, during the follow-up period. After adjustment for several potential confounders, hazard ratios for total and cardiac mortality were 0.77 (0.51-1.15) and 0.61 (0.36-1.02) for those drinking >0-<5 g per day, 0.77 (0.50-1.18) and 0.62 (0.36-1.07) for those drinking 5-20 g per day, and 0.89 (0.56-1.40) and 0.69 (0.38-1.25) for those drinking over 20 g per day. Risk of hospitalization for recurrent non-fatal AMI, stroke, or heart failure generally showed a similar pattern to that of total and cardiac mortality. Recent quitters at the time of AMI had a hazard ratio of 4.55 (2.03-10.20) for total mortality. Measures of insulin sensitivity appeared to be the strongest mediators of this association.CONCLUSIONSModerate alcohol drinking might have beneficial effects on several aspects of long-term prognosis after an AMI. Our findings also highlight that former drinkers should be examined separately from long-term abstainers. The potential mechanisms that underlie this association still need to be elucidated.