Background: Cerebrovascular disease (CVD) can be an important future cardiovascular event. The impact of previous cerebrovascular disease (CVD) on the clinical characteristics and midterm outcomes of patients (pts) with acute myocardial infarction (AMI) has not been well described in Asian population. Methods: Data were analyzed from 8151 pts with AMI (either STEMI or NSTEMI) enrolled in Korea Acute Myocardial Infarction Registry (KAMIR) from 2005 to 2007. Results: Of 8151 pts, 552 pts (6.8%) had previous CVD. The pts with CVD were older (68.95 짹 10.11 vs 62.83 짹 12.74, P<0.001), more incidence in women (70.4% vs 62.7%, P<0.001), showed higher incidence of hypertension and diabetes than the pts without CVD. The pts with previous CVD presented more often with NSTEMI and higher Killip class than the pts without CVD. Further, pts with CVD received less percutaneous coronary intervention (PCI) or thrombolysis compared with the pts without CVD. Intensive medical therapy was equally maintained in both groups. Pts with CVD showed higher incidences of cardiac death [13.6% vs 5.1%, adjusted odd ratio (OR) 2.11, 95% confidence interval (CI) 1.60-2.79, P<0.001], total death (15.9% vs 5.9%, adjusted OR 2.15; 95% CI 1.65-2.80, P<0.001) and total major adverse cardiac events (MACE, 23.0% vs 11.6%, adjusted OR 1.45; 95% CI 1.14-1.85, P=0.003) at 8 months. The incidences of recurrent MI and repeat revascularization at 8 months were similar between the two groups. Conclusions: Pts with CVD showed more severe and worse clinical characteristics on admission and was associated with lower rates of PCI or thrombolysis. When we consider the poorer midterm clinical outcomes including higher mortality and MACE, in pts with prior CVD, more intensive and aggressive management for this particular subset of pts should be emphasized for better long-term clinical outcomes.