BACKGROUND We sought to explore the prognostic power of certain patient characteristics to predict myocardial contractile recovery after coronary revascularization in patients with prior myocardial infarction. METHODS We enrolled 100 consecutive patients with prior myocardial infarction, significant coronary stenosis/occlusion amenable for revascularization, and regional wall motion abnormality in the distribution of the affected artery. All patients underwent echocardiographic assessment of regional wall motion and left ventricular ejection fraction. Patients underwent coronary revascularization by either percutaneous angioplasty or surgical bypass. Echocardiography was repeated 8 weeks following revascularization. Patients were classified into two groups: Group 1 with evidence of contractile improvement after revascularization at follow-up echocardiography and Group 2 with no such evidence of improvement. The two groups were compared with respect to patients' clinical characteristics and echocardiographic and angiographic data. RESULTS Predictors of contractile recovery after revascularization included angina pectoris, the shorter age of infarction at the time of revascularization, a higher baseline left ventricular ejection fraction, a lower baseline wall motion score index, the presence of Grade 2-3 collaterals to the infarct-related artery, and the absence of dyspnea or diabetes mellitus. Stepwise regression analysis identified the presence of Grade 2-3 collaterals to the infarct-related artery and the age of infarction at the time of revascularization as independent predictors of contractile recovery after revascularization. CONCLUSIONS In patients with prior myocardial infarction, the presence of Grade 2-3 collaterals to the infarct-related artery and the shorter age of infarction at the time of revascularization independently predicted myocardial contractile recovery after coronary revascularization.