Backgrounds There are few available data of the incidence, predictors and clinical outcome of newly developed cerebrovascular accident (CVA) in patients with acute myocardial infarction (AMI) after successful revascularization during hospitalization. Methods and Results We analyzed 5,473 AMI patients underwent successful percutaneous coronary intervention from Korea working group on myocardial infarction registry between Jan. 2008 and Jun. 2009. Of these, 17 patients (0.3%) developed CVA during their hospitalization. Patient with CVA were more likely to have systolic blood pressure (SBP) less than 100mmHg at admission (46.7% vs. 9.9%, p<0.001) and tended to be common in female gender than those without CVA (47.1% vs. 27.9%, p=0.079) but, there were no significant differences in the other baseline characteristics between groups. Cardiogenic shock during hospitalization occurred more frequently in patients with CVA than those without CVA (23.5% vs. 4.7%, p=0.008). Patients with CVA had significantly higher incidence of in-hospital mortality than those without CVA (17.6% vs. 3.2%, p=0.017). Left ventricular ejection fraction [Odds ratio (OR)=0.942; 95% Confidence interval (CI)=0.920-0.964], creatinine clearance (OR=0.981; 95% CI=0.965-0.997), cardiogenic shock (OR=18.292; 95% CI=0.9.020-37.097) and developed CVA during hospitalization (OR=55.585; 95% CI=8.534-362.056) were independent predictors for in-hospital mortality in AMI patients. The independent predictors of development of CVA in AMI patient during hospitalization were systolic blood pressure lower than 100mmHg at admission (OR=11.161; 95% CI=2.020-61.665), Killip class III (OR=5.591; 95% CI=1.144-27.319) and history of diabetes (OR=4.360; 95% CI=1.032-18.430). Conclusion CVA is a rare but very serious complication and associated with in-hospital mortality in AMI patients. Low systolic blood pressure at admission, Killip class III and history of diabetes are independent predictors of CVA.