To investigate the impact of prior cerebral infarction (PCI) on in-hospital mortality in patients with Acute Myocardial Infarction (AMI). A retrospective analysis of documents of a total of 3572 consecutive patients with AMI admitted to Xuanwu Hospital of Capital Medical University from 2002 Jan. 1 to 2009 Dec. 31 were performed. There were 564 patients (15.8%) with PCI. Compared with the group of without PCI, the group with PCI were substantially older [(69.4 ± 9.9) vs (64.2 ± 12.9) years, P = 0.000], and had a higher prevalence of hypertensive disease, diabetes mellitus, prior myocardial infarction (MI) and non-ST-segment elevation myocardial infarction (NSTEMI) (respectively, 71.0% vs 57.3%; 41.0% vs 25.7%, 12.9% vs 9.5%; 14.9% vs 10.7%, P < 0.01), and a higher in-hospital mortality (16.5% vs 10.0%, P = 0.000). Univariate analysis demonstrated that in-hospital mortality associated with age, gender, extensive anterior MI, anterior MI, diabetes mellitus, prior cerebral infarction, prior myocardial infarction, coronary angiography and percutaneous coronary intervention. Logistic regression analysis found that risk factors were age, extensive anterior MI, anterior MI, diabetes mellitus and prior cerebral infarction, and protective factors were coronary angiography and percutaneous coronary intervention. PCI was independently associated with in-hospital mortality, OR 1.368, 95%CI 1.047 - 1.787, P = 0.022. In patients with acute myocardial infarction, the presence of PCI increases the risk of worse in-hospital outcome.