BACKGROUND Perfusion defects (PDs) detected with cardiac magnetic resonance (CMR) imaging predict the functional recovery of myocardial function after acute myocardial infarction. OBJECTIVE We evaluated the ability of cardiac computed tomography (CCT) to predict the recovery of regional left ventricular (LV) systolic function after ST elevation myocardial infarction (STEMI). METHODS Seventeen patients (mean age, 60610 years) presenting with STEMI were prospectively studied. Each patient underwent CCT and CMR at baseline and after an average of 6 months. Areas of PD were quantified. Segmental LV systolic function was semiquantitatively assessed by CMR. An improvement at 6 months by R1 category in the regional wall motion score was considered LV recovery. RESULTS Coronary artery revascularization was successfully performed with post procedural TIMI 3 flow in 16 cases. On CCT assessment, 107 of 289 segments (37%) had some degree of PD. On follow-up, segments with,25%PD at baseline had no worsening of wall motion. In segments with.75%PD, 89% (9 of 11) showed akinesis or worsening of wall motion. The odds ratio for improvement in segmental wall motion with increasing PD category was 0.63 (95% CI, 0.42-0.97; P 5 0.035). The degree of PD on CT predicted LV recovery at follow-up (P , 0.0001). CONCLUSIONS The transmural extent of myocardial infarction as detected and quantified with CCT predicts the recovery of regional systolic LV function after revascularization for acute STEMI.