Background: Cigarette smoking is a well established major modifiable risk factor for acute myocardial infarction (AMI). The impact of current smoking on mid-term clinical outcomes of AMI according to different gender has not been well described. Methods: A total 6648 eligible AMI patients (pts) in Korean Acute Myocardial Infarction Registry (KAMIR) including 3051 (45.9%) male smokers, 1313 (19.8%) male non-smokers, 272 (4.1%) female smokers and 2012 (30.3%) female nonsmokers were enrolled for this study. The clinical characteristics and outcomes up to 8 months between different genders were evaluated. Results: Male smokers with AMI showed higher body mass index, worse lipid profiles, younger age, less hypertension and diabetes, and STEMI was more common compared to those of male non-smokers. Female smokers had similar age, body mass index, and coronary risk factors, except for a higher incidence of STEMI compared to those of female non-smokers. At 8 months, male smokers with AMI showed lower incidences of cardiac death (3.2% vs 6.5%, P<0.001), total death (3.6% vs 7.2%, P<0.001), and total major adverse cardiac events (MACE, 9.6% vs 13.7%, P<0.001) compared to male non-smokers but the repeat AMI and repeat revascularization were not different between the two groups. However, these outcome differences didn���t exist in female smoker vs. non-smoker pts. Multivariate logistic analysis showed cigarette smoking didn���t independently influence on the 8-month clinical outcomes including mortality, repeat AMI, repeat revascularization and total MACE either in male or female patients (P>0.05). Conclusions: Regardless of gender, smokers were more likely to present with STEMI. Male smokers showed better mid-term clinical outcomes than male non-smoker, suggesting ���Smoker���s Paradox��� possibly due to their younger age and less conventional risk factors. However, after adjusting baseline differences, cigarette smoking failed to show better influence on mid-term clinical outcomes of both in male and female AMI pts.