Background: According to several reports, patients who smoke paradoxically have favorable outcomes after acute myocardial infarction (AMI) compared with nonsmokers. We sought to determine the relationship between cigarette smoking and outcomes after AMI. Methods: From November 2005 to July 2010, a total of 2139 (1532 men, 64.8짹12.2 years) patients with AMI who underwent percutaneous coronary intervention (PCI) were categorized into two groups: group I (current smoker: n=885, 834 men, 58.8짹11.8 years) and group II (former smoker or nonsmoker: n=1254, 698 men, 69.0짹10.6 years). We evaluated one-year major adverse cardiac events (MACEs) including all cause death, myocardial infarction, repeated PCI and coronary artery bypass grafting. Results: In comparison to group II, group I were younger (58.8짹11.8 years vs. 69.0짹10.6 years, p<0.001), more often men (94.2% vs. 55.7%, p<0.001), more frequently had one vessel coronary disease (52.7% vs. 45.1%, p=0.001), lesion type B1 (22.3% vs. 16.5%, p=0.001) and less frequently had diabetes (24.0% vs. 31.4%, p<0.001), hypertension (36.4% vs. 57.6%, p<0.001), history of ischemic heart disease (10.3% vs. 15.6%, p<0.001), and three vessel coronary disease (13.0% vs. 19.3%, p<0.001). Patients in Group I were higher Killip class I (80.7% vs. 71.5%, p<0.001), lower Killip class III (5.9% vs. 11.4%, p<0.001). The incidence rate of MACEs during one-year clinical follow-up was significantly lower in group I (18.3% vs. 23.7%, p=0.003). After multivariate correction for differences in other variables with binary logistic regression, however, current smoking status was not an independent prognostic factor for MACEs (odds ratio 1.024, 95% CI 0.791-1.324, p=0.858). Conclusion: Current smoking status was no longer protective from MACEs, although the smoker���s paradox extends to patients undergoing PCI for AMI, with decreased MACEs seen in current smokers.