Background: Cigarette smoking was associated with higher rates of myocardial infarction (MI) and death from coronary artery disease. However, despite the increased prevalence of ischemic heart disease in current smokers, prior studies showed that smokers undergoing primary percutaneous coronary intervention (PCI) had lower mortality rate than nonsmokers. The impact of cigarette smoking in patients with acute MI after drug-eluting stent (DES) implantation has not been examined. Methods: From databases of our hospital, 1242 patients who confirmed acute MI and underwent successful PCI with DES were consecutively enrolled. Cardiac death, non-fatal MI, target lesion revascularization at 12 months after procedure were assessed. Results: Five hundred fifty patients (44.3%) were current smokers. In comparison to nonsmokers, current smokers were younger, more often men, less frequently had diabetes, hypertension and hyperlipidemia, showed lower serum creatinine level, and frequent medication of ACE inhibitor. Cardiac mortality at 12 months was significantly lower in current smokers (1.1% vs. 3.0%, p=0.019). However, current smoking status was no longer protective from cardiac mortality in multivariate analysis (hazard ratio 0.395, 95% CI 0.130~1.195, p=0.100). Conclusions: The current smoker showed increased survival than nonsmoker. However, its result entirely explained by difference in baseline risk factors.