Background Limited data are available on patients with chronic lung disease (CLD) presenting with acute myocardial infarction (AMI). We aimed to analyse baseline characteristics, treatment and outcome of those patients enrolled in the Swiss nationwide prospective AMIS Plus registry. Methods All AMI patients enrolled between January 2002 and December 2021 with data on CLD, as defined in the Charlson Comorbidity Index, were included. The primary endpoints were in‐hospital mortality and major adverse cardiac and cerebrovascular events (MACCE), defined as all‐cause death, reinfarction and cerebrovascular events. Baseline characteristics, in‐hospital treatments and outcomes were analysed using descriptive statistics and logistic regression. Results Among 53,680 AMI patients enrolled during this time, 5.8% had CLD. Compared with patients without CLD, CLD patients presented more frequently with non‐ST‐elevation myocardial infarction (MI) and type 2 MI (12.8% vs. 6.5%, p < 0.001). With respect to treatment, CLD patients were less likely to receive P2Y12 inhibitors (p < 0.001) and less likely to undergo percutaneous coronary interventions (68.7% vs. 82.5%; p < 0.001). In‐hospital mortality declined in AMI patients with CLD over time (from 12% in 2002 to 7.3% in 2021). Multivariable regression analysis showed that CLD was an independent predictor for MACCE (adjusted OR was 1.28 95% CI 1.07–1.52, p = 0.006). Conclusion Patients with CLD and AMI were less likely to receive evidence‐based pharmacologic treatments, coronary revascularization and had a higher incidence of MACCE during their hospital stay compared to those without CLD. Over 20 years, in‐hospital mortality was significantly reduced in AMI patients, especially in those with CLD. We analysed patients with acute myocardial infarction (AMI) and chronic lung disease (CLD) over 20 years. Primary endpoints of this study were in‐hospital and major cardiac and cerebrovascular events. Patients with CLD were less likely to receive percutaneous coronary interventions than those without CLD. Non‐ST‐elevation myocardial infarction (MI) and type 2 MI were more likely to occur in patients with CLD. In‐hospital mortality and MACCE declined in AMI patients, especially in those with CLD over time.