Objective: To study the impact of stress hyperglycemia on the short-term prognosis of acute ST-segment elevation myocardial infarction (STEMI) in patients with a history of ischemic stroke. Method: We reviewed the records of 387 patients with a history of ischemic stroke who presented to the cardiology department of Xuanwu Hospital with acute ST-segment elevation myocardial infarction (AMI) between January 2005 and January 2011. The patients were divided into two groups based on in-hospital cardiac death: mortality and survival. The medical information of the hospitalized patients was comprehensively collected. Results: The mortality group had older age, more men, higher admission blood glucose levels, more patients with Killip class >= II, as well as higher rates of revascularization than did the survival group. Multivariate logistic regression revealed that sex, admission heart rate, stress hyperglycemia, peak troponin I (TnI) level, and revascularization, were independent factors affecting the short-term prognosis of acute STEMI in patients with a history of ischemic stroke. Additionally, there was a significant association between admission blood glucose level and in-hospital mortality. Conclusion: Stress hyperglycemia is an independent risk factor for poor prognosis of acute STEMI in patients with a history of ischemic stroke.