ST-elevation myocardial infarction (STEMI) is one of the most serious developments of coronary artery disease. This condition receives a lot of attention because it affects a lot of people, especially those with underlying cardiac diseases. STEMI can lead to several cardiac complications, such as transmural myocardial injury and obstruction of the heart microvasculature, which can result in clinical heart failure. One of the major modifiable risk factors of cardiovascular diseases is smoking. Many studies reported that this behavior can increase the risk of STEMI, especially in some populations. Smoking can cause damage to the coronary microvascular components, hence the infarct of related cardiac tissues. However, there were several findings that considered smoking as a protective factor for STEMI patients. This review article aims to evaluate the role of smoking behavior in STEMI cases from prior studies.