Background: Metabolic syndrome is the risk factor of coronary artery disease (CAD). But the relation between hyperlipidemia and the success rate of primary coronary intervention (PCI), the short-term outcome of that after acute myocardial infarction is not well established. Methods: 5766 eligible patients (4061 males, 65.0짹12.8 years) enrolled in Korea Acute Myocardial infarction Registry (KAMIR) were analyzed. The level of low density lipoprotein-cholesterol (LDL-C) was divided into 5 groups (<70, 70~99, 100~129, 130~159, ���160mg/dL). High-risk coronary anatomy (HRCA) as the severity index of CAD was defined as significant left main artery and/or significant 3-vessel CAD. Results: High LDL-C group (���100 mg/dL) patients were younger, and higher prevalences of female sex, diabetes, abdominal obesity, hypertriglyceridemia which met ATP III metabolic syndrome criteria. Mean LDL-C was lower in successful PCI group (114.1짹39.4 vs. 118.3짹36.6 mg/dL, p=0.015). As LDL-C increasing, the success rate of primary PCI was increased (83.0% vs. 87.7% vs. 87.5% vs. 90.7% vs. 88.6%, p=0.003). After covariate adjustment with age, sex, and the component of metabolic syndrome, LDL-C was the independent predictor of the primary PCI success (OR, 1.249; CI, 1.024-1.524; p=0.028). But LDL-C was not associated with HRCA (p=0.215), type of coronary artery lesion (p=0.732). LDL-C was negative independent predictor of 30-day mortality (OR, 0.655; CI, 0.486-0.887; p=0.005), although 1-month MACE was not different among LDL-C groups. Conclusions: Although metabolic syndrome is the risk factor of CAD, the higher level of LDL-C is associated with the higher success rate of primary PCI as well as the lower 30-day mortality.