Background: Left ventricular (LV) remodelling is significant predictor of survival after timely reperfusion therapy in ST elevation myocardial infarction (STEMI). Cardiovascular Magnetic Resonance Imaging (CMR) after reperfusion therapy in STEMI provides useful findings such as microvascular obstruction (MVO), and transmural necrosis which can predict adverse outcomes. Recently, hemorrhagic myocardial infarction (MI) on CMR was reported that it is related to MVO and infarct size. Methods: Patients who received percutaneous coronary intervention (PCI) for STEMI were enrolled from single center between September 2005 and November 2009. CMR was performed a median days of 9 after PCI. And echocardiography was performed at initial and follow-up visit. We investigate the clinical significance of hemorrhagic MI in relation to MVO or transmural necrosis or coronary artery lesion and whether these CMR findings can predict the LV remodelling on the follow-up echocardiography. Results: We evaluated 125 patients undergoing PCI for STEMI. The median follow-up duration was 6 months. Mean age was 56.6 짹 12.4. The hemorrhagic MI was noted to 67 patients.(54%) In patients with involving LM or LAD coronary artery, the total segment numbers of MVO area and transmural necrosis and hemorrhagic MI were higher than the other group.(2.53 짹 2.30 vs 1.47 짹 1.45, p = 0.002, 5.73 짹 3.29 vs 3.43 짹 1.96 p < 0.001, 2.01 짹 2.22 vs 1.0 짹 1.26 p = 0.002, respectively) The presence of hemorrhagic MI was well related to the presence of MVO(N = 67 vs N = 18, p < 0.001) and the total segment numbers of MVO area, transmural necrosis(3.22 짹 1.96 vs 0.77 짹 1.21, 6.03 짹 2.86 vs 3.32 짹 2.55, all p-values < 0.001) and infarct size(%).(27.5 짹 15.1 vs 13.8 짹 10.4, p < 0.001) In linear regression analysis, the difference of basal and follow-up LVEDVI was correlated to infarct size (%) (p = 0.006) but not to total segment numbers of MVO and transmural necrosis and hemorrhagic MI. (p = 0.452, p = 0.082, p = 0.581, respectively) Conclusions: Hemorrhagic MI in CMR was highly associated with presence of MVO, larger infarct size and MVO area and transmural necrosis and LM or LAD disease. LV remodelling estimated on echocardiography was predicted by infarct size, but not by hemorrhagic MI, MVO in CMR.